text:
Decrease in Trunk Muscular Response to Perturbation With Preactivation of Lumbar Spinal Musculature
- April Chandler
- 2 years ago
- Views:
1 Decrease in Trunk Muscular Response to Perturbation With Preactivation of Lumbar Spinal Musculature SPINE Volume 25, Number 15, pp , Lippincott Williams & Wilkins, Inc. Ian A.F. Stokes, PhD,* Mack Gardner-Morse, MS,* Sharon M. Henry, PT, PhD, and Gary J. Badger, MS Study Design. An experimental study of healthy subjects trunk muscle responses to force perturbations at differing angles and steady state efforts. Objectives. To determine whether increased preactivation of muscles was associated with decreased likelihood of muscular activation in response to a transient force perturbation. Summary of Background Data. Trunk stability (ability to return to equilibrium position after a perturbation) requires the stiffness of appropriately activated muscles to prevent buckling and consequent self-injury. Therefore, greater trunk muscle preactivation might decrease the likelihood of reflex muscle responses to small perturbations. Methods. Each of 13 subjects stood in an apparatus with the pelvis immobilized. A harness around the thorax provided a preload and a force perturbation by a horizontal cable and a movable pulley attached to one of five anchorage points on a wall track surrounding the subject at angles of 0, 45, 90, 135, and 180 to the forward direction. Subjects first equilibrated with a preload effort of nominally 20% or 40% of their maximum extension effort. Then a single full sine-wave force perturbation pulse of nominal amplitude, 7.5% or 15% of maximum effort, duration 80 milliseconds or 300 milliseconds, was applied at a random time, with three repeated trials of each test condition. The applied force (via a load cell) and the electromyographic activity of six right and left pairs of trunk muscles were recorded. Muscle responses were detected by two methods. 1) Shewhart method: electromyographic signal greater than baseline values by more than three standard deviations, and 2) Mean Electromyographic Difference method: mean electromyographic signal in a time window 25 to 150 milliseconds after the force perturbation greater than that in a 25- to 150-millisecond window before the perturbation. Results. Lower preload efforts were associated with more muscle responses (overall mean response detection rate 33% at low preload and 25% at high preload). Using the Shewhart method, there were significant differences by effort (P 0.05) for all abdominal muscles and for all left dorsal muscles except multifidus. Using the Mean Electromyographic Difference method, there were significant differences by effort (P 0.05) for the same dorsal muscles, but only for one of the abdominal muscles. Conclusions. Findings are consistent with the hypothesis that the spine can be stabilized by the stiffness of From the Departments of *Orthopaedics and Rehabilitation, Physical Therapy, and Medical Biostatistics, University of Vermont, Burlington, Vermont. Supported by National Institutes of Health R01 AR Acknowledgement date: June 22, First revision date: September 7, Acceptance date: November 23, Device status category: 1. Conflict of interest category: 14. activated muscles, obviating the need for active muscle responses to perturbations. [Key words: spine stability, muscle stiffness, perturbation, human subjects, electromyography] Spine 2000; The vertebrae of the lumbar spine are like a series of inverted pendulums, producing a ligamentous spine that is inherently unstable. Stability in this context is defined as the ability of a system to return to its equilibrium position after a small perturbation. The spine must be stabilized by the stiffness of the muscles and motion segments to prevent buckling. Otherwise, a sudden excessive displacement could occur and result in tissue injury. It has been shown analytically that muscle stiffness, which increases with intensity of muscle activation, can prevent lumbar spine buckling that would occur otherwise in subjects under loaded conditions or when experiencing a perturbation. 2,5,7 11 Therefore, the patterns of human trunk muscle recruitment not only must provide static equilibrium and appropriate response to changes in loading and displacement perturbations, but also must provide sufficient stiffness to ensure stability of the vertebral column. 1,2,6,7,10,14,16,18,19,24,25,27,30 Coactivation of antagonistic muscles is a part of a strategy that can increase the muscular stiffness and hence stability, but at the cost of increased spinal loads. 11,12,20,21 The restoration of equilibrium after a perturbation can be achieved by active adjustment of muscle tensions, but with inherent neuromuscular delays. 28,29 Alternatively, small perturbations might be accommodated without such active responses, provided there is sufficient muscular stiffness and damping in the trunk. The present study is concerned with the second mechanism. The biomechanics of such passive stabilization that requires no active central nervous system-mediated adjustment of the preset muscle activation or stiffness after a perturbation was demonstrated theoretically by Bergmark, 2 and has been further explored analytically. 5,7 11 This mechanism of trunk stabilization is difficult to study experimentally, and for practical and ethical reasons experimental investigations of stability in human subjects must focus on the strategies that are used to prevent spinal buckling or other instability events. The present study was designed to investigate spinal stability by recording whether trunk muscles were recruited in response to a transient perturbation, with different magnitudes of preloading. Because muscle stiffness increases with activation, it was expected that the trunk would be stiffer under more heavily loaded conditions; 1957
2 1958 Spine Volume 25 Number Figure 1. a, Parameters of the preload effort and of the force perturbation. b, Diagram of a subject standing in the apparatus, maintaining a steady-state preload effort to which a force perturbation can be added, here with an anterior acting force at 0 (i.e., extension effort). EMG electromyography. therefore, an active response to a force perturbation would be less likely to occur for the same magnitude of perturbation. This study used a transient full-sine wave force perturbation to study the hypothesis that a stable trunk would not require muscular responses to the perturbation. A full sine-wave minimizes the momentum imparted to the subject, and there is no change in load magnitude after the perturbation. For these experiments, the perturbation was in the form of a single sine-wave force superimposed on a steady-state preload effort. This loading was chosen because the preload effort served to preactivate the trunk muscles, and the sinusoidal perturbation may not require an obligatory response, thus allowing study of the conditions under which no responses occurred. The purpose of this investigation was to test the research hypothesis that an increase in preload effort results in decreased numbers of trunk muscle responses after a force perturbation, where a response is defined as increased muscle activation (measured by electromyographic (EMG) signal magnitude) above that before the perturbation. This was tested in 12 trunk muscles for five different loading directions because the muscles would be activated differently to oppose forces in different loading directions. Also investigated was whether the preload effort or perturbation characteristics altered the magnitude of muscle responses and whether the likelihood of a response depended on the perturbation amplitude and speed. Methods Thirteen healthy subjects (7 men, 6 women; age years; height m; bodymass kg) were studied after they signed the informed consent form that had been approved by the Committee on Human Research. Each stood in an apparatus with the pelvis effectively immobilized by a support structure with pads pressing on the regions over the anterior superior iliac spines and the sacrum (Figure 1). A harness around the thorax was connected by a cable and pulley to a system for applying a horizontal steady-state preload, together with a superimposed force perturbation of variable (and controlled) amplitude and duration (Figure 1a). The cable was aligned approximately horizontal and level with the T12 vertebra. The pulley was attached to one of five anchorage points on a wall track surrounding the subject at angles of 0, 45, 90, 135, and 180 to the anterior direction. The mechanical system for generating the force perturbation (Figure 1b) consisted of a variable speed electric motor driving an eccentriccrank lever system by a single turn electromagnetic clutch. The clutch was activated by the experimenter pushing a button that caused the shaft connected to the clutch to execute a single turn. This produced a single full sine-wave displacement of the lever arm attached to the two springs in line with the cable connected to the harness around the subject. The amplitude of the sinusoidal displacement and the stiffness of the springs determined the amplitude of the force perturbation superimposed on the preload efforts. Initially, the cable was anchored to the wall at 0 (extension effort), and subjects generated a timed ramped load test up to their maximum effort in 5 seconds with a further 5 seconds for gradual release of the load. Three trials were performed to help subjects learn how to achieve a maximum effort. The maximum achieved was used as the basis for determining the preload effort and perturbation amplitude in the perturbation experiments. At each of the five test angles (the sequence of angles was randomly selected), subjects first generated a steady-state preload of nominal magnitudes 20% and 40% of the maximum force recorded in extension effort. An analog voltmeter with a target mark was used to help subjects maintain the desired steady-state preload effort by providing visual feedback of the force recorded by a load cell in the cable. The subjects were instructed to maintain a normal erect posture, symmetrically oriented with the apparatus during all tests. Then a single full sine-wave force perturbation pulse (nominal amplitude 7.5% or 15% of maximum effort, nominal duration 80 milliseconds or 300 milliseconds) was applied by the investigator without warning after a random time between 5 to 20 seconds after the subject reached the desired steady-state preload effort. The subjects had experienced the force perturbations in a practice session before the recorded trials. They were instructed to try to maintain the needle position at the mark on the analog voltmeter. There were eight test conditions at each angle (two preload efforts, two pulse amplitudes, and two pulse durations), all of which were presented randomly. Three repeated trials were made in sequence of each test condition for a total of 24 trials
3 Decreased Muscle Response to Perturbation With Preactivation Stokes et al 1959 Figure 2. Example of the recorded force (top panel) and the EMG signal (lower panel, for left longissimus) in a perturbation experiment. The EMG signal is filtered and rectified. The Shewhart threshold (mean 3 standard deviations of the signal in a preperturbation window) is indicated by a horizontal line. The dashed vertical lines indicate the 25- to 150-millisecond window for response detection. Here, a response with a latency of 57.6 milliseconds was detected. at each of the five test angles and a grand total of 120 perturbation trials per subject. The total time of the testing session was approximately 4 hours, but the longest duration of a sustained effort was approximately 30 seconds. Subjects could rest between trials and while the load direction and perturbation parameters were altered. To measure the displacement of the subject occurring at the harness, a linear displacement transducer with a resolution of 0.1 mm was mounted next to the wall anchor point and was connected to the harness by a light string. The preload efforts averaged N when nominally 20% of maximum effort and N when nominally 40% of maximum effort. The force perturbation amplitude averaged 47 N when set to 7.5% of maximum effort and 87 N when set to 15% of maximum effort. Electromyelography. Bipolar EMG electrodes recorded signals from six right and left pairs of muscles (rectus abdominis, internal and external obliques, longissimus, iliocostalis, and multifidus). Surface electrodes were used except for multifidus, whose activity was recorded by 50- m nickel alloy indwelling wires connected to Motion Control Inc., Type (Salt Lake City, UT USA) preamplifiers taped to the adjacent skin. Dorsal muscles and the oblique abdominal muscles were recorded by surface electrodes (Delsys Inc. Type DE-02.3, Boston, MA, USA). For rectus abdominis, neonatal Ag/AgCl monitoring electrodes with nominally 30-mm spacing were applied and connected to adjacently mounted Motion Control Inc. Type amplifiers. The Delsys electrodes have 10- mm 1-mm silver bar electrodes with 10-mm spacing; their single differential amplifiers have a gain of 1000, 20 Hz to 450 khz bandwidth, 92 db (typical) common mode rejection ratio, and ohms input impedance. The Motion Control single differential amplifiers have gain of 3000, 10 Hz to 24 khz bandwidth, 100 db common mode rejection ratio and ohms input impedance. A ground electrode was placed over the anterior aspect of the tibia. Electromyelographic and load cell signals were recorded digitally at 2048 or 1024 Hz. Electrodes were placed as follows: rectus abdominis 30 mm lateral to the midline at the level of the umbilicus, aligned vertically; external oblique halfway between the iliac crest and the 12th rib along the midaxillary line, aligned at an 80 angle to the horizontal; internal oblique 20 mm medial and superior to the anterior superior iliac spine, aligned at 45 ; longissimus 30 mm lateral to the midpoint of the spinous process of L3, aligned vertically; iliocostalis 60 mm lateral to the midpoint of the spinous process of L3, aligned vertically. For multifidus, fine wire electrodes 22 were fabricated from 50- m gauge nylon-insulated twisted wire pairs with a 2-mm long uninsulated section set back 5 mm on one wire and 9 mm on the other. A posteroanterior radiograph with subjects in the prone position was used to locate the spinous process of L4 with the help of lead balls as reference points set into a plastic sheet that was placed over the lumbar region. The electrode insertion point was 5 mm lateral to the edge of the L4 spinous process and 10 mm cranial to the inferior aspect of the L4 spinous process. The wires were threaded through a needle that was inserted at a 90 angle to the skin surface until the periosteum of the L4 lamina was contacted, then the needle cannula was withdrawn, leaving the two wires in place. This procedure was intended to place the bare sections of the wires in the individual muscle slip of multifidus that inserts at L3. 13,23 Signal Processing. First, EMG signals were bandpass filtered by a 10- to 100-Hz Chebyshev type II filter with no lag and rectified. The filtration was intended to reduce any electrocardiograph (EKG) or motion artifact and high frequency noise contamination of the signals. A 25-millisecond moving average of the rectified EMG signal then was calculated. The onset of the force perturbation was first identified from the load cell recording by detecting the time at which there was a significant increase in the force-time slope (Figure 2). A 25- to 150- millisecond time window after the force perturbation was examined using two different methods to detect any short and medium latency muscle responses to the perturbation. Suspect data resulting from technical problems such as loose electrodes or EKG artifacts were excluded from further statistical analyses. These records were eliminated by a dual process of visual inspection and identification of outliers. A multipleturning point algorithm was used to identify probable EKG and motion artifacts, and these were identified in traces of EMG versus time by custom software. Each detected onset then was visually inspected, and the first onset not identified as an artifact was accepted. For outliers caused by electrical transients associated with the electromagnetic clutch, recordings with a Mean EMG Difference greater than five times the mean EMG in a preperturbation window were eliminated. This criterion was established by inspection of the response magnitude distribution. For the 13 subjects, with five loading directions, two preload magnitudes, two perturbation amplitudes, and two perturbation durations, with three repetitions of each test condition, there were a total of 1560 possible trials. Of these, 170
4 1960 Spine Volume 25 Number were not completed for technical reasons. Of the resulting 16,680 muscle recordings (12 muscles per trial), 1772 were eliminated because of artifacts in recordings. Of these, 576 were from left multifidus muscles and 572 were from right multifidus muscles. Response Detection by Shewhart Method. 15 A muscle response to force perturbation was considered to occur if the processed EMG signal exceeded a threshold of three standard deviations (SDs) above a baseline mean. The false-positive rate of this method was estimated by applying the same detection criterion to a to 875-millisecond window preceding the perturbation. The baseline mean was computed using the median mean EMG signal magnitude in five sequential 100- millisecond windows in the 500 milliseconds preceding the force perturbation. The standard deviation of the 100- millisecond window corresponding to the median mean was used to compute the three standard deviation threshold. Using the median minimized the potential effect of outliers resulting from EMG contamination by EKG or other artifacts. When a response was detected, its latency was measured as the time from the start of the force perturbation to onset of the EMG response. Response Detection by Mean EMG Difference Method. The difference between the mean EMG signal in a 25- to 150- millisecond window after the perturbation and a 275- to 150- millisecond window before the perturbation was computed for each EMG signal. A response was defined as an increase in the mean EMG signal after perturbation (i.e., a positive mean EMG difference). The observed number of responses was examined relative to the 50% rate expected by chance if there were no true increase in muscle activity. This detection method was not influenced by the differences in the standard deviation of the baseline EMG signal between experimental conditions that potentially could produce detection bias with the Shewhart method. Latencies could not be calculated by this method. Response Magnitude. The magnitude of the mean EMG difference was used to test for differences in response magnitude across experimental conditions. These analyses were performed separately for trials in which a response was detected by each of the two previously defined criteria. Statistical Analyses. The response frequency (measured by the Shewhart or Mean EMG Difference method) was measured (for each muscle under each testing condition) as the average of the dichotomous response scores from the three replicate trials. Repeated measures analyses of variance were used to determine the significance associated with differences in average response frequency as a function of steady-state preload, angle, perturbation amplitude, perturbation speed, and their potential interactions. Separate analyses were performed for each muscle. Because the primary dependent measure was an estimated muscle response frequency from three repeated trials, these data were subjected to an arcsine square root transformation before analysis to satisfy the assumptions of the analyses of variance. 3 Magnitudes of responses, measured by values of the Mean EMG Difference, were also compared between experimental conditions using repeated measures analyses of variance. These analyses were performed separately for trials in which a response was detected using each of the two detection criteria. All statistical analyses were performed using SAS statistical software (SAS Institute, Cary NC). Statistical significance was determined based on Results When averaged for all muscles, only 28.9% of recordings showed a detectable muscle response by the Shewhart method, with individual muscles response frequencies ranging from 16% (right multifidus muscle) to 42% (right and left rectus abdominis muscles). Low preload efforts were associated with higher muscle response frequencies (Figures 3 and 4). When averaged for all test conditions, the average number of trials producing a detected response was observed to be greater at low preload than at high preload for all 12 muscles (overall response frequency: 33% vs. 25% by Shewhart method, 0.77 vs for Mean EMG Difference method). Using the Shewhart method, there were significantly more detected responses at low preload effort (P 0.05) for right and left internal and external obliques, right and left rectus abdominis, left longissimus, and left iliocostalis. These eight muscles produced estimated response frequencies averaging 37% for the low preload condition compared with 27% for high preload. Using the Mean EMG Difference method, there were significantly more responses at low preload effort (P 0.05) for the same dorsal muscles, but for only one of the abdominal muscles (right external oblique). Greater perturbation amplitude produced significantly more detected responses in all but one muscle (right multifidus). Responses were detected by the Shewhart method in 20% of trials (averaged across muscles) with low perturbation amplitude compared with 38% of trials with high amplitude perturbation. The number of false-positive responses detected by the Shewhart method in the preperturbation window averaged 5.66% across all muscles and testing conditions. This is much lower than the number of responses detected in the postperturbation window (28.9%). The magnitudes of responses as measured by the mean EMG difference were observed to be greater by 24% (averaged for all muscles) at high preloads for responses detected by the Shewhart method and by 20% for responses detected by the mean EMG difference method. These differences only reached statistical significance, however, for the right rectus abdominis. The magnitudes of the responses were significantly greater (by an overall average 1.3 times) for larger perturbations at both preload efforts. Also, there were significantly larger responses at force angles for which the muscles were opposite to the applied force direction. The largest magnitude responses occurred when the force acted at 0, 45, or at 90 for dorsal muscles (longissimus, iliocostalis, and multifidus), 135 or 180 for the oblique abdominal muscles, and at 180 for the rectus abdominis. The average response magnitude was between 1.5 times and 7.6 times greater at these angles than at the
5 Decreased Muscle Response to Perturbation With Preactivation Stokes et al 1961 Figure 3. Detected responses to a force perturbation (Shewhart method) of trunk flexor and extensor muscles (% of total number of trials) as a function of angle of the effort. Left and right muscles are plotted separately for low (20%) and high (40%) preload efforts: F left muscles; f right muscles, dashed line low (20%) preload effort, solid line high (40%) preload effort. The figurine, viewed from above, and the arrow indicate the direction of the preload and perturbation forces. angles where the lowest magnitude responses were observed. There was no evidence that the speed of stimulus had any influence on response magnitude. There were also no significant perturbation speed effects on the number of detected muscle responses except that there were more responses at higher speeds for right rectus abdominis (48% and 37% response frequency at high and low speed respectively) and right external oblique (32% and 23% for high and low speed, respectively). The latency of detected responses after the onset of the force perturbation is summarized in the histogram in Figure 5, showing that most detected responses occurred within 100 milliseconds of the onset of the force perturbation. There were no significant differences in latency between experimental conditions. The force perturbations produced an average displacement of 2.91 mm for low amplitude perturbations and 5.9 mm for high amplitude perturbations at the low (20% effort) preload. For 40% effort preloads, the perturbations caused lesser displacements (averages of 1.9 mm and 4.4 mm for low amplitude and high amplitude perturbations). The high speed perturbations caused approximately half as much trunk displacement as the low speed perturbations. Discussion The results of this study show that the amount of preactivation of the trunk musculature (determined by the preload effort) influenced the likelihood of muscular response to a force perturbation. As hypothesized, the likelihood of a muscular response was less when the preload effort was higher. A change in muscular activation was detected in a minority of recordings when the preloaded trunk was perturbed by a force pulse. This is consistent with the hypothesis that the spine may be stabilized by the stiffness of preactivated muscles, avoiding the need for an active response to perturbations. For
6 1962 Spine Volume 25 Number Figure 4. Detected responses to a force perturbation (proportion of total number of trials) by the Mean EMG Difference Method of trunk flexor and extensor muscles as a function of angle of the effort. Left and right muscles are plotted separately for low (20%) and high (40%) preload efforts: F left muscles, f right muscles. Dashed line low (20%) preload effort; solid line high (40%) preload effort. The figurine, viewed from above, and the arrow indicate the direction of the preload and perturbation forces. Note: the expected frequency of response detection by chance is 0.5 if no responses occurred. some muscles at certain angles (e.g., the left iliocostalis in extension efforts), the number of detected responses at low preload was approximately twice that at high preload. In most other cases, however, the difference by preload was less marked. Reliable response detection was difficult because detected responses were small relative to the fluctuation of the EMG signal from preactivated muscles. To compromise between false-positive and false-negative detections, the Shewhart threshold for detection was set as the mean plus three standard deviations of the steady-state EMG signal. The median of the heights of detected EMG responses was only 3.96 standard deviations above the preperturbation mean, and 80% had peaks less than six standard deviations. The number of responses detected by the Mean EMG Difference method would be 0.5 (by chance) if there were no muscular responses; therefore, the proportions of responses detected by these two methods are not directly comparable. Despite concern that the Shewhart detection algorithm might be influenced by the level of preactivation of the muscle and would thereby be biased by the preload effort, the consistency of response frequencies and preload effects between the two detection methods (Shewhart and Mean EMG Difference) indicates that this was not a problem. Increased amplitude of force perturbation increased the number of responses, as expected, but the number of responses was relatively insensitive to both the speed of perturbation and the angle of the force. The observed muscle response latency in the range 25 to 150 milliseconds is indicative of a monosynaptic reflex (probably stretch reflex) or medium latency response. The responses that occurred at the lower end of this latency range were not unexpected, because the short conduction distances for reflexes in paraspinal muscles allow rapid responses to direct stimulation of paraspinal structures. 17,26 The observed muscle responses that occurred in some cases are consistent with triggering by muscle
7 Decreased Muscle Response to Perturbation With Preactivation Stokes et al 1963 Figure 5. Histograms of detected muscle responses at different latencies after the onset of force perturbation in the 25- to 150- millisecond detection window. spindles, Golgi tendon organ, joint mechanoreceptors, or cutaneous sensory afferents, or a combination of these, based on the magnitude of forces applied through the harness (on the order of 50 N) and the thorax displacements induced (on the order of 2 to 6 mm). Because the exact triggering pathways are unknown, it is difficult to speculate on why responses were inhibited with higher preload. The preactivation of the muscles and increased activity of the gamma system could increase the sensitivity of the muscle spindles, thus increasing the likelihood of a response. This speculation goes against the hypothesis of the present study and is contrary to what was found. The increased stiffness at higher preload reduced the displacements occurring, however, perhaps lessening the role of spindles in triggering a response. These neurophysiologic mechanisms would predict a reciprocal response of muscles based on whether they were stretched or shortened by the perturbation. Because there was no clear reciprocal pattern evident, the probability of response could be determined by a threshold phenomenon that changes depending on the state of the entire system, including local spinal inhibition and supraspinal (perhaps back lifting mediated) inhibition influenced by central set. The absence of large differences in number of detected responses by force direction (Figures 4 and 5) is suggestive of a common central drive of responses to these perturbations, such that muscle recruitment is directionally nonspecific under these conditions. Previous studies of trunk muscle responses to force perturbations have used a sudden increase or decrease in load by a dropped weight or a sudden release. 4,6,19,24,30 These produce both step and impulse loading and require an obligatory muscle response of trunk muscle responses. The paradigm in the present study used a transient perturbation to study the hypothesis that a stable trunk would not require muscular responses. In studies in which a response was obligatory, Lavender and Marras 19,24 found that if their subjects were expecting the sudden loading from a dropped weight, there were anticipatory activations of trunk muscles, especially of abdominal muscles. They noted that the resulting muscular forces could cause large forces on the spine, but presumably they also increase the muscle stiffness and hence increase trunk stability. Carlson et al 4 and Cresswell et al 6 used a similar paradigm with weights suddenly added or removed from a harness over the shoulders. They observed that the abdominal muscles were usually the first to activate. Wilder et al 30 reported the latency of responses to sudden perturbation (from a dropped weight) in the range of milliseconds, with evidence that latency was increased with muscle fatigue. In subjects with low back pain, latency was longer than in others, but the latency of the trunk muscle EMG responses was reduced after an exercise program. The results of these experiments provide insights into how the central nervous system controls muscle preactivation in expectation of a perturbation and when responses to external force perturbations are triggered. The likelihood of muscle responses was greater at low preload effort and for greater perturbation amplitude, as expected. The angle of the force direction and the perturbation speed had no strong effect on the responses. The fact that most of these perturbations did not elicit a detectable muscle response supports the contention that the spine is stabilized by the stiffness of preactivated muscles, obviating the need for active (central nervous system-mediated) responses. Key Points Trunk stability was defined as its ability to return to an equilibrium position after a perturbation. Muscles can actively assist in restoring the equilibrium position by alteration of their activation, and the stiffness of activated muscles stabilizes the loaded spine. It was found that the likelihood of muscle active response to a perturbation would reduce with preactivation of the muscles, because muscles then would be stiffer. Acknowledgment Much of the experimental work was performed by David Norton. References 1. Bean JC, Chaffin DB, Schultz AB. Biomechanical model calculation of muscle contraction forces: A double linear programming method. J Biomech 1988;21: Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl 1986;230: Box GEP, Hunter WG, Hunter JS. Statistics for Experimenters: An Introduction to Data Analysis, and Model Building. New York: John Wiley & Sons, 1978:231 8.
8 1964 Spine Volume 25 Number Carlson H, Nilsson J, Thorstensson A, Zomlefer MR. Motor responses in the human trunk due to load perturbations. Acta Physiol Scand 1981;111: Cholewicki J, Panjabi MM, Khachatryan A. Stabilizing function of trunk flexor extensor muscles around a neutral spine posture. Spine 1997;22: Cresswell AG, Oddsson L, Thorstensson A. The influence of sudden perturbations on trunk muscle activity and intraabdominal pressure while standing. Exp Brain Res 1994;98: Crisco JJ 3d, Panjabi MM. The intersegmental and multisegmental muscles of the lumbar spine. A biomechanical model comparing lateral stabilizing potential. Spine 1991;16: Crisco JJ, Panjabi MM. Euler stability of the human ligamentous lumbar spine. Part 1: Theory. Clinical Biomechanics 1992;7: Crisco JJ, Panjabi MM, Yamamoto I, Oxland TR. Euler stability of the human ligamentous lumbar spine. Part 2: Experimental. Clinical Biomechanics 1992;7: Gardner-Morse M, Stokes IA, Laible JP. Role of muscles in lumbar spine stability in maximum extension efforts. J Orthop Res 1995;13: Gardner-Morse MG, Stokes IAF. The effects of abdominal muscle coactivation on lumbar spine stability. Spine 1998;23: Granata KP, Marras WS. The influence of trunk muscle coactivity on dynamic spinal loads. Spine 1995;20: Haig AJ, Moffroid M, Henry S, Haugh L, Pope, MH. A technique for needle localization in paraspinal muscles with cadaveric confirmation. Muscle Nerve 1991;14: Henry SM, Fung J, Horak FB. Control of stance during lateral and anterior/ posterior surface translations. IEEE Trans Rehabil Eng 1998;6: Hodges PW, Bui BH. A comparison of computer-based methods for the determination of onset of muscle contraction using electromyography. Electroencephalogr Clin Neurophysiol 1996;101: Hughes RE, Chaffin DB, Lavender SA, Andersson GB. Evaluation of muscle force prediction models of the lumbar trunk using surface electromyography. J Orthop Res 1994;12: Indahl A, Kaigle A, Reikeras O, Holm S. Electromyographic response of the porcine multifidus musculature after nerve stimulation. Spine 1995;20: Krajcarski S, Potvin JR, Chiang J. The in vivo dynamic response of the spine to perturbations causing rapid flexion: Effects of preload and step input magnitude. Clinical Biomechanics 1999;14: Lavender SA, Mirka GA, Schoenmarklin RW, et al. The effects of preview and task symmetry on trunk muscle response to sudden loading. Hum Factors 1989;31: Lavender SA, Tsuang YH, Andersson GB, Hafezi A, Shin CC. Trunk muscle coactivation: The effects of moment direction and moment magnitude. J Orthop Res 1992;10: Lavender SA, Tsuang YH, Hafezi A, Andersson GB, Chaffin DB, Hughes RE. Coactivation of the trunk muscles during asymmetric loading of the torso. Hum Factors 1992;34: Loeb GE, Gans K. Design and construction of electrodes. In: Electromyography for Experimentalists. Chicago, IL: University of Chicago Press, 1986: MacIntosh JE, Bogduk N. The morphology of the lumbar erector spinae. Spine 1991;16: Marras WS, Rangarajulu SL, Lavender SA. Trunk loading and expectation. Ergonomics 1987;30: Schultz AB. Biomechanical analyses of loads on the lumbar spine. In: The Lumbar Spine. Weinstein JN, Wiesel SW, eds. Philadelphia, PA: W.B. Saunders, 1990: Solomonow M, Zhou BH, Harris M, Lu Y, Baratta RV. The ligamentomuscular stabilizing system of the spine. Spine 1998;23: Stokes IAF, Gardner-Morse M. Lumbar spine maximum efforts and muscle recruitment patterns predicted by a model with multijoint muscles and flexible joints. J Biomech 1995;28: Thelen DG, Schultz AB, Ashton-Miller JA. Quantitative interpretation of lumbar muscle myoelectric signals during rapid cyclic attempted trunk flexions and extensions. J Biomech 1994;27: Vos EJ, Harlaar J, van Ingen Schenau GJ. Electromechanical delay during knee extensor contractions. Med Sci Sports Exerc 1991;23: Wilder DG, Aleksiev AR, Magnusson ML, Pope MH, Spratt KF, Goel VK. Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation. Spine 1996;21: Address reprints requests to Ian A.F. Stokes Department of Orthopaedics and Rehabilitation University of Vermont Burlington, VT 05405
Intra-abdominal pressure mechanism for stabilizing the lumbar spine
Journal of Biomechanics 32 (1999) 13 17 Intra-abdominal pressure mechanism for stabilizing the lumbar spine Jacek Cholewicki *, Krishna Juluru, Stuart M. McGill Biomechanics Research Laboratory, DepartmentMore information
Research Report. Abdominal Muscle Response During Curl-ups on Both Stable and Labile Surfaces
Research Report Abdominal Muscle Response During Curl-ups on Both Stable and Labile Surfaces Background and Purpose. With the current interest in stability training for the injured low back, the use ofMore information
Clinical Biomechanics
Clinical Biomechanics 25 (2010) 859 866 Contents lists available at ScienceDirect Clinical Biomechanics journal homepage: www.elsevier.com/locate/clinbiomech Intra-abdominal pressure and abdominal wallMore information
PHYSIOLOGY AND MAINTENANCE Vol. IV - Lumbar Muscle Function and Dysfunction in Low Back Pain - Markku Kankaanpää
LUMBAR MUSCLE FUNCTION AND DYSFUNCTION IN LOW BACK PAIN Markku Department of Physical Medicine and Rehabilitation, Kuopio University Hospital, and Department of Physiology, University of Kuopio, FinlandMore information
Stability of the spine modelled as an arch
Loughborough University Institutional Repository Stability of the spine modelled as an arch This item was submitted to Loughborough University's Institutional Repository by the/an author. Citation: XIAO,More information
Chiropractic Medicine and Chronic Pain Hands-on Demonstration. Tom Arnold, DC, APC, DAAMLP UNM Pain Center & Private Practice Albuquerque, New Mexico
Chiropractic Medicine and Chronic Pain Hands-on Demonstration Tom Arnold, DC, APC, DAAMLP UNM Pain Center & Private Practice Albuquerque, New Mexico No disclosures Presentation Objectives At the conclusionMore information
OPTIMAL CORE TRAINING FOR FUNCTIONAL GAINS AND PEAK PERFORMANCE: CXWORX Jinger S. Gottschall 1, Jackie Mills 2, and Bryce Hastings 2 1 The Pennsylvania State University, University Park, USA 2 Les MillsMore information
Mechanics of the Human Spine Lifting and Spinal Compression
Mechanics of the Human Spine Lifting and Spinal Compression Hamill and Knutzen: Chapter 7 Nordin and Frankel: Ch. 10 by Margareta Lindh Hall: Ch. 9 (more muscle anatomy detail than required) Low Back PainMore information
Low Back Pain Mansour Dib MD Physical Medicine and Rehabilitation Pain generators Disc Posterior elements Sacro-iliac joint Education - Spine Positioning Neutral Extension Flexion Disc disease DiscogenicMore information
The Effect of Different Standing and Sitting Postures on Trunk Muscle Activity in a Pain-Free Population
The Effect of Different Standing and Sitting Postures on Trunk Muscle Activity in a Pain-Free Population SPINE Volume 27, Number 11, pp 1238 1244 2002, Lippincott Williams & Wilkins, Inc. Peter B. O Sullivan,More information
Biomechanics of Lifting and Lower Back Pain S.N. Robinovitch
Biomechanics of Lifting and Lower Back Pain S.N. Robinovitch Outline Epidemiology of lower back pain Strength of spinal segments Lifting models: muscle and intervertebral joint forces (compression andMore information
ARTICLE IN PRESS. Journal of Biomechanics
Journal of Biomechanics 41 (2008) 2821 2828 Contents lists available at ScienceDirect Journal of Biomechanics journal homepage: www.elsevier.com/locate/jbiomech www.jbiomech.com Neuromuscular neutral zonesMore information
THE INFLUENCE OF WALL PAINTING ON SHOULDER MUSCLE ACTIVITY AND HORIZONTAL PUSH FORCE Background: Patricia M. Rosati and Clark R. Dickerson Department of Kinesiology, University of Waterloo, Waterloo, ONMore information
Nervous System: Spinal Cord and Spinal Nerves (Chapter 13) Lecture Materials for Amy Warenda Czura, Ph.D. Suffolk County Community College
Nervous System: Spinal Cord and Spinal Nerves (Chapter 13) Lecture Materials for Amy Warenda Czura, Ph.D. Suffolk County Community College Primary Sources for figures and content: Eastern Campus Marieb,More information
Chapter 13. The Nature of Somatic Reflexes
Chapter 13 The Nature of Somatic Reflexes Nature of Reflexes (1 of 3) A reflex is an involuntary responses initiated by a sensory input resulting in a change in a gland or muscle tissue occur without ourMore information
Intervertebral Stiffness of the Spine Is Increased by Evoked Contraction of Transversus Abdominis and the Diaphragm: In Vivo Porcine Studies
Intervertebral Stiffness of the Spine Is Increased by Evoked Contraction of Transversus Abdominis and the Diaphragm: In Vivo Porcine Studies SPINE Volume 28, Number 23, pp 2594 2601 2003, Lippincott WilliamsMore information
Reflex Physiology. Dr. Ali Ebneshahidi. 2009 Ebneshahidi
Reflex Physiology Dr. Ali Ebneshahidi Reflex Physiology Reflexes are automatic, subconscious response to changes within or outside the body. a. Reflexes maintain homeostasis (autonomic reflexes) heartMore information
External torque as a factor to modify load in abdominal curl-up exercises
Original Paper Biomedical Human Kinetics, 7, 16 22, 2015 DOI: 10.1515/bhk-2015-0003 External torque as a factor to modify load in abdominal curl-up exercises Alicja Rutkowska-Kucharska, Agnieszka SzpalaMore information
Trunk muscle recruitment patterns in specific chronic low back pain populations
Clinical Biomechanics 20 (2005) 465 473 www.elsevier.com/locate/clinbiomech Trunk muscle recruitment patterns in specific chronic low back pain populations Sheri P. Silfies a, *, Dawn Squillante b, PhilipMore information
Basic techniques of pulmonary physical therapy (I) 100/04/24
Basic techniques of pulmonary physical therapy (I) 100/04/24 Evaluation of breathing function Chart review History Chest X ray Blood test Observation/palpation Chest mobility Shape of chest wall AccessoryMore information
Biomechanical Analysis of the Deadlift (aka Spinal Mechanics for Lifters) Tony Leyland
Biomechanical Analysis of the Deadlift (aka Spinal Mechanics for Lifters) Tony Leyland Mechanical terminology The three directions in which forces are applied to human tissues are compression, tension,More information
PROCEEDINGS of the HUMAN FACTORS AND ERGONOMICS SOCIETY 49th ANNUAL MEETING 2005 1354 ERGONOMIC FIELD ASSESSMENT OF BUCKING BARS DURING RIVETING TASKS Michael J. Jorgensen and Muthukurappan ViswanathanMore information
Low back pain in athletes requires unique rehab approach
UBM logo BioMechanics November 2004 spacer Printable Version spacer Low back pain in athletes requires unique rehab approach By: Michael Higgins, PhD, ATC, PT Many athletes sustain low back injuries thatMore information
Structural behavior of human lumbar spinal motion segments
ARTICLE IN PRESS Journal of Biomechanics 37 (2004) 205 212 Structural behavior of human lumbar spinal motion segments Mack G. Gardner-Morse*, Ian A.F. Stokes Department of Orthopaedics and Rehabilitation,More information
The One-Leg Standing Test and the Active Straight Leg Raise Test: A Clinical Interpretation of Two Tests of Load Transfer through the Pelvic Girdle
Diane Lee BSR, FCAMT, CGIMS Published in the Orthopaedic Division Review 2005 I read with interest and some concern the discussion in the last issue of the Orthopaedic Division Review on evidence basedMore information
The Science Behind MAT
The Science Behind MAT Muscle Activation Techniques (MAT) is a system designed to evaluate and treat muscular imbalances, I will expand on the process of evaluation in response and the use of isometricsMore information
Author: Dr. Society of Electrophysio. Reference: Electrodes. should include: electrode shape size use. direction.
Standards for Reportin ng EMG Data Author: Dr. Roberto Merletti, Politecnico di Torino, Italy The Standards for Reporting EMG Data, written by Dr. Robertoo Merletti, are endorsed by the International SocietyMore information
SPINE. Postural Malalignments 4/9/2015. Cervical Spine Evaluation. Thoracic Spine Evaluation. Observations. Assess position of head and neck
SPINE Observations Body type Postural alignments and asymmetries should be observed from all views Assess height differences between anatomical landmarks Figure 25-9 Figure 25-10 Figure 25-11 & 12 PosturalMore information
American Osteopathic Academy of Sports Medicine James McCrossin MS ATC, CSCS Philadelphia Flyers April 23 rd, 2015
American Osteopathic Academy of Sports Medicine James McCrossin MS ATC, CSCS Philadelphia Flyers April 23 rd, 2015 Coming together is a beginning; keeping together is progress; working together is success.More information
Determining the Posture, Shape and Mobility of the Spine
Determining the Posture, Shape and Mobility of the Spine The World of Biomechanics Assessment of the Mobility Function Using a special Triple Cervical marker set comprising miniature ultrasound transmitters,More information
Current Concepts of Low Back Pain. Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS
Current Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS 28% population reports LBP in past 3 months (CDC 2010) 60% recurrence rate (Turner et al, 1992) Low Back Pain Low Back PainMore information
Compensation for Interaction Torques During Single- and Multijoint Limb Movement
Compensation for Interaction Torques During Single- and Multijoint Limb Movement PAUL L. GRIBBLE AND DAVID J. OSTRY McGill University, Montreal, Quebec H3A 1B1, Canada Gribble, Paul L. and David J. Ostry.More information
Rehabilitation after ACL Reconstruction: From the OR to the Playing Field. Mark V. Paterno PT, PhD, MBA, SCS, ATC
Objectives Rehabilitation after ACL Reconstruction: From the OR to the Playing Field Mark V. Paterno PT, PhD, MBA, SCS, ATC Coordinator of Orthopaedic and Sports Physical Therapy Cincinnati Children sMore information
Spinal Anatomy. * MedX research contends that the lumbar region really starts at T-11, based upon the attributes of the vertebra.
Spinal Anatomy Overview Neck and back pain, especially pain in the lower back, is one of the most common health problems in adults. Fortunately, most back and neck pain is temporary, resulting from short-termMore information
How to Get and Keep a Healthy Back. Amy Eisenson, B.S. Exercise Physiologist
How to Get and Keep a Healthy Back Amy Eisenson, B.S. Exercise Physiologist Lesson Objectives Statistics of Back Pain Anatomy of the Spine Causes of Back Pain Four Work Factors Core Muscles ConnectionMore information
Stretching the Low Back THERAPIST ASSISTED AND CLIENT SELF-CARE STRETCHES FOR THE LUMBOSACRAL SPINE
EXPERT CONTENT by Joseph E. Muscolino photos by Yanik Chauvin body mechanics THE ESSENCE OF MOST MANUAL THERAPIES, and certainly clinical orthopedic massage therapy, is to loosen taut soft tissues, therebyMore information
Flexion relaxation response to gravity
ARTICLE IN PRESS Journal of Biomechanics 39 (26) 2545 2554 www.elsevier.com/locate/jbiomech www.jbiomech.com Flexion relaxation response to gravity Michael Olson a,c, Moshe Solomonow b,c,,lili a,c a DepartmentMore information
The Importance of Developing a Primary Core Stability Protocol
The Importance of Developing a Primary Core Stability Protocol Angela M. Homan, SPT Duke University Doctor of Physical Therapy Intern SportsMedicine of Atlanta Dr Robert E DuVall PT, DHSc, MMSc, ATC, OCS,More information
Laboratory Guide. Anatomy and Physiology
Laboratory Guide Anatomy and Physiology TBME04, Fall 2010 Name: Passed: Last updated 2010-08-13 Department of Biomedical Engineering Linköpings Universitet Introduction This laboratory session is intendedMore information
Treatment of Low Back Pain Using the MyoRack System: Description of the Treatment and Preliminary Findings
Biofeedback Volume 36, Issue 3, pp. 98 103 SPECIAL SECTION Association for Applied Psychophysiology & Biofeedback www.aapb.org Treatment of Low Back Pain Using the MyoRack System: Description of the TreatmentMore information
AP Physics C. Oscillations/SHM Review Packet
AP Physics C Oscillations/SHM Review Packet 1. A 0.5 kg mass on a spring has a displacement as a function of time given by the equation x(t) = 0.8Cos(πt). Find the following: a. The time for one completeMore information
Body Ball Exercises SUPINE TRUNK CURL TRUNK EXERCISES. Tomado de : Bodytrends.com
Body Ball Exercises Tomado de : Bodytrends.com TRUNK EXERCISES Each of the following exercises has two to three intensity or complexity variations. Level I variations are described first and are the easiestMore information
NETWORK FITNESS FACTS THE HIP The Hip Joint ANATOMY OF THE HIP The hip bones are divided into 5 areas, which are: Image: www.health.com/health/static/hw/media/medical/hw/ hwkb17_042.jpg The hip joint isMore information
What is Pilates? Pilates for Horses?
What is Pilates? Pilates is a conditioning system that increases core stability, strength and body awareness; redresses imbalances, and re aligns the body from the inside out. It can improve posture, achieveMore information
Enhancing Low Back Health through stabilization exercise Stuart M. McGill, Professor (Spine Biomechanics), University of Waterloo
Enhancing Low Back Health through stabilization exercise Stuart M. McGill, Professor (Spine Biomechanics), University of Waterloo Note: Dr McGill has recently authored the text book Low Back Disorders:More information
I tro r duct c io i n t o Exercise Technique
Introduction to Exercise Technique Is Exercise Technique Important? It is the actual technique used for a resistance training exercise that determines; The precise movement pattern the body will be attemptingMore information
iworx Sample Lab Experiment HN-2: Stretch Receptors and Reflexes
Experiment HN-2: Stretch Receptors and Reflexes Exercise 1: Achilles Tendon Reflex Aim: To determine conduction time from tendon tap to response of the gastrocnemius muscle in the Achilles tendon reflexMore information
Harmonics and Noise in Photovoltaic (PV) Inverter and the Mitigation Strategies
Soonwook Hong, Ph. D. Michael Zuercher Martinson Harmonics and Noise in Photovoltaic (PV) Inverter and the Mitigation Strategies 1. Introduction PV inverters use semiconductor devices to transform theMore information
Product Introduction MyoMuscle. Telemyo DTS-System. Telemetry system for EMG and Biomechanical Sensors. www.noraxon.com
Product Introduction MyoMuscle Telemyo DTS-System Telemetry system for EMG and Biomechanical Sensors DTS Device Family 3 major device categories can be used for the Direct Transmission System technologyMore information
The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain
The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain SPINE Volume 27, Number 4, pp 399 405 2002, Lippincott Williams & Wilkins, Inc. Carolyn A. Richardson,More information
Body posture or posture control in back pain patients
Body posture or posture control in back pain patients André Ljutow Centre for Pain Medicine, Nottwil What is this lecture about? Due to the possibility to measure human posture questions like «What isMore information
Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain
Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain Barbara Hungerford, PhD,* Wendy Gilleard, PhD, and Paul Hodges, PhD SPINE Volume 28, Number 14, pp 1593 1600More information
Understanding back pain 1 The anatomy & physiology of back pain
Understanding back pain 1 The anatomy & physiology of back pain Dr James Tang, MBA, BDS, LDS RCS General Dental Practitioner, Level 3 Personal Trainer (REP registration no R1045463), Sports NutritionistMore information
Basic Biomechanics. What is Kinesiology? Why do we need Kinesiology? the body as a living machine for locomotion
Basic Biomechanics the body as a living machine for locomotion What is Kinesiology? Kinesis: To move -ology: to study: The study of movement What the heck does that mean? Why do we need Kinesiology? AsMore information
THE SWISS BALL (or gym ball) is widely reported in the. Core Stability Exercises On and Off a Swiss Ball
242 Core Stability Exercises On and Off a Swiss Ball Paul W. Marshall, PG Dip Sci, Bernadette A. Murphy, PhD ABSTRACT. Marshall PW, Murphy BA. Core stability exercises on and off a Swiss ball. Arch PhysMore information
REDISTRIBUTION OF LOAD OF INJURED LOWER CERVICAL SPINE UNDER AXIAL COMPRESSION USING FEM E. C. Teo 1 and H. W. Ng 1 1 School of Mechanical and Production Engineering, Nanyang Technological University,More information
Anatomy and Physiology for Exercise and Health Level 3
Anatomy and Physiology for Exercise and Health Level 3 A/600/9051 Mock Paper There are 25 questions within this paper To achieve a pass you will need to score 18 out of 25 marks All questions are multipleMore information
Lumbar Spondylolisthesis or Anterolisthesis Patient Educational Information
Lumbar Spondylolisthesis or Anterolisthesis Patient Educational Information What is a Spondylolisthesis or Anterolisthesis? Spondylolisthesis is a condition of the spine when one of the vertebra slipsMore information
Data Analysis Methods: Net Station 4.1 By Peter Molfese
Data Analysis Methods: Net Station 4.1 By Peter Molfese Preparing Data for Statistics (preprocessing): 1. Rename your files to correct any typos or formatting issues. a. The General format for naming filesMore information
CASE STUDY: SI JOINT SEPARATION LAURA LONG, PT, ATC, CSCS The pelvic girdle includes the sacrum and ilium bones which connect posteriorly to form two sacroiliac (SI) joints. The SI joint relies highlyMore information
BESTest Balance Evaluation Systems Test Fay Horak PhD Copyright 2008
BESTest Balance Evaluation Systems Test Fay Horak PhD Copyright 2008 TEST NUMBER/SUBJECT CODE DATE EXAMINER NAME EXAMINER Instructions for BESTest 1. Subjects should be tested with flat heeled shoes orMore information
Flexibility, Static and Dynamic Stretching, and Warm-Up
Readings: Flexibility, Static and Dynamic Stretching, and Warm-Up NSCA text: Chapter 12 pp 251 260, 266-274 Course web site: Supplemental optional reading articles on course web site discussed and citedMore information
Plyometric Training. Plyometric Training. chapter
chapter 16 Plyometric Training Plyometric Training David H. Potach, PT; MS; CSCS,*D; NSCA-CPT,*D Donald A. Chu, PhD; PT; ATC; CSCS,*D; NSCA-CPT,*D; FNSCA Chapter Objectives Explain the physiology of plyometricMore information
DINAMIC AND STATIC CENTRE OF PRESSURE MEASUREMENT ON THE FORCEPLATE. F. R. Soha, I. A. Szabó, M. Budai. Abstract
ACTA PHYSICA DEBRECINA XLVI, 143 (2012) DINAMIC AND STATIC CENTRE OF PRESSURE MEASUREMENT ON THE FORCEPLATE F. R. Soha, I. A. Szabó, M. Budai University of Debrecen, Department of Solid State Physics AbstractMore information
Avoid The Dreaded Back Injury by Proper Lifting Techniques
Avoid The Dreaded Back Injury by Proper Lifting Techniques If you ve ever strained your back while lifting something, you ll know the importance of lifting safely. Agenda Introduction About the Back TheMore information
Aetna Nerve Conduction Study Policy
Aetna Nerve Conduction Study Policy Policy Aetna considers nerve conduction velocity (NCV) studies medically necessary when both of the following criteria are met: 1. Member has any of the following indications:More information
Validity of Surface EMG Testing A Review of the relevant literature and legal precedence Written by David Marcarian, MA
Surface EMG and Validity: September 2008 Page 1 of 6 Validity of Surface EMG Testing A Review of the relevant literature and legal precedence Written by David Marcarian, MA To Whom It May Concern: ThisMore information
Muscle Terminology. Intrinsic - pertaining usually to muscles within or belonging solely to body part upon which they act
Muscle Terminology Intrinsic - pertaining usually to muscles within or belonging solely to body part upon which they act Ex. small intrinsic muscles found entirely within the hand or feet Muscle TerminologyMore information
AP1 Oscillations. 1. Which of the following statements about a spring-block oscillator in simple harmonic motion about its equilibrium point is false?
1. Which of the following statements about a spring-block oscillator in simple harmonic motion about its equilibrium point is false? (A) The displacement is directly related to the acceleration. (B) TheMore information
Psoas Syndrome. The pain is worse from continued standing and from twisting at the waist without moving the feet.
Psoas Syndrome The iliopsoas muscle is a major body mover but seldom considered as a source of pain. Chronic lower back pain involving the hips, legs, or thoracic regions can often be traced to an iliopsoasMore information
CHAPTER V RESEARCH QUESTION 1 CORE STABILITY: ANATOMICAL, BIOMECHANICAL AND PHYSIOLOGICAL EVIDENCE Christopher McLean 1 There has been a significant amount of work published in the past 15 years investigatingMore information
Understand Your Back & Pelvic Girdle Pain
Understand Your Back & Pelvic Girdle Pain Written by Diane Lee Physiotherapist Updated January 2011! Introduction Back pain happens to everyone and, for some, is a life-changing occurrence. The causesMore information
Hip Rehab: Things to Consider. Sue Torrence, MS, PT, ATC Lead Physical Therapist
Hip Rehab: Things to Consider Sue Torrence, MS, PT, ATC Lead Physical Therapist Where to Start? Objectives: Discuss injuries related to hip dysfunction Review commonly used functional tests for posteriolateralMore information
Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression
Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression 1 Journal of Neurosurgery: Spine November 2009, Volume 11, pp.More information
The lumbar multifidus muscle and patterns of pain
ARTICLE IN PRESS Manual Therapy 11 (2006) 40 45 Original article The lumbar multifidus muscle and patterns of pain Jon Cornwall a, A. John Harris b, Susan R. Mercer a, a Department of Anatomy and StructuralMore information
The Assessment of Musculoskeletal Injury Risks Among Steel Manufacturing Workers
The Assessment of Musculoskeletal Injury Risks Among Steel Manufacturing Workers Hazards are ever-present in the steel plant environment, and a heightened awareness and emphasis on safety is a necessaryMore information
Mary LaBarre, PT, DPT,ATRIC
Aquatic Therapy and the ACL Current Concepts on Prevention and Rehab Mary LaBarre, PT, DPT,ATRIC Anterior Cruciate Ligament (ACL) tears are a common knee injury in athletic rehab. Each year, approximatelyMore information
Anatomy and Pathomechanics of the Sacrum and Pelvis. Charles R. Thompson Head Athletic Trainer Princeton University
Anatomy and Pathomechanics of the Sacrum and Pelvis Charles R. Thompson Head Athletic Trainer Princeton University Simplify Everything There are actually only three bones: Two innominates, one sacrum.More information
Strength Exercises for Improved Running Biomechanics
2 CHAPTER Strength Exercises for Improved Running Biomechanics ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssdd s Many gait abnormalities seenMore information
Temple Physical Therapy
Temple Physical Therapy A General Overview of Common Neck Injuries For current information on Temple Physical Therapy related news and for a healthy and safe return to work, sport and recreation Like UsMore information
Musculoskeletal System
CHAPTER 3 Impact of SCI on the Musculoskeletal System Voluntary movement of the body is dependent on a number of systems. These include: The brain initiates the movement and receives feedback to assessMore information
A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH)
A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) Introduction Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a phenomenon that more commonly affects older males. It is associatedMore information
Chapter 12 The Trunk and Spinal Column
Chapter 12 The Trunk and Spinal Column Manual of Structural Kinesiology R.T. Floyd, EdD, ATC, CSCS Vertebral Abdominal 24 31 most column complex some intricate & complex articulating vertebrae do pairsMore information
A Thesis. Entitled. The Effects of Core Stability Training on Star Excursion Balance. Test and Global Core Muscular Endurance.
A Thesis Entitled The Effects of Core Stability Training on Star Excursion Balance Test and Global Core Muscular Endurance By Alex McCaskey Submitted to the Graduate faculty as partial fulfillment of theMore information
Fundamental Movement Skills: Balancing Mobility and Stability
Fundamental Movement Skills: Balancing Mobility and Stability Of the three components of RAW functional fitness, movement skills tend to get the least emphasis. However, the other two components (strengthMore information
Movement artifacts electrical noise caused by the movement of the sensor surface with respect to the skin surface
BIOHARNESS 42 Aero Camino, Goleta, CA 93117 Tel (805) 685-0066 Fax (805) 685-0067 firstname.lastname@example.com www.biopac.com 12.15.08 Field Comparison: Zephyr BioHarness / Polar HR Monitor Introduction The ZephyrMore information
Real Time Ultrasound (RTUS) imaging of the stabilizing muscles of the spine and torso is now available at Marda Loop Sport Physiotherapy.
Real Time Ultrasound (RTUS) imaging of the stabilizing muscles of the spine and torso is now available at Marda Loop Sport Physiotherapy. Stabilizing Muscles of the Spine & Torso Core muscles that areMore information
2002 Functional Design Systems
1. Proprioceptive sensitivity has to do with not being too sensitive but being sensitive enough. 2. The hammies have a lot to do with all three planes of function. 3. In upright function, knee flexionMore information
Hills St. Sports Medicine & Rehabilitation Centre
LUMBAR SPINE PREVENTATIVE & REHABILITATION PROGRAM Theron King B. Ed. (Sports Science) Hills St. Sports Medicine & Rehabilitation Centre Denny Shearwood B.APP.SC. (Physiotherapy) M.A.P.A. Appointed PhysiotherapistMore information
MET: Posterior (backward) Rotation of the Innominate Bone.
MET: Posterior (backward) Rotation of the Innominate Bone. Purpose: To reduce an anterior rotation of the innominate bone at the SI joint. To increase posterior (backward) rotation of the SI joint. Precautions:More information
Experimental determination of cervical spine mechanical properties
Acta of Bioengineering and Biomechanics Vol. 10, No. 4, 2008 Experimental determination of cervical spine mechanical properties MAREK GZIK*, WOJCIECH WOLAŃSKI, DAGMARA TEJSZERSKA Division of General MechanicsMore information
Prevention & Management of ACL Injury. Ian Horsley PhD, MCSP Lee Herrington PhD, MCSP
Prevention & Management of ACL Injury Ian Horsley PhD, MCSP Lee Herrington PhD, MCSP ACL injury ACL injury 30/100,000, 40% sports injuries (NHS) Limited statistics in UK related to sport Rugby Union 2002-2004More information
Workflow 4. Elite sitting volleyball players have better trunk control than healthy untrained individuals
Workflow Elite sitting volleyball players have better trunk control than healthy untrained individuals Journal: Adapted Physical Activity Quarterly Manuscript ID: Draft Manuscript Type: Original ResearchMore information
Muscle Energy Technique. Applied to the Shoulder
Muscle Energy Technique Applied to the Shoulder MUSCLE ENERGY Theory Muscle energy technique is a manual therapy procedure which involves the voluntary contraction of a muscle in a precisely controlledMore information
.org. Cervical Radiculopathy (Pinched Nerve) Anatomy. Cause
Cervical Radiculopathy (Pinched Nerve) Page ( 1 ) Cervical radiculopathy, commonly called a pinched nerve occurs when a nerve in the neck is compressed or irritated where it branches away from the spinalMore information
Neural Plasticity and Locomotor Recovery: Robotics in Research
International Neurorehabilitation Symposium February 12, 2009 Neural Plasticity and Locomotor Recovery: Robotics in Research Keith Tansey, MD, PhD Director, Spinal Cord Injury Research Crawford ResearchMore information
The non-surgical alternative for disc problems, scoliosis, and spinal curve restoration.
The non-surgical alternative for disc problems, scoliosis, and spinal curve restoration. The premise behind the Vibrating Traction is simple. Research done by top scientists has suggested that occupationalMore information
Screening Examination of the Lower Extremities BUY THIS BOOK! Lower Extremity Screening Exam
Screening Examination of the Lower Extremities Melvyn Harrington, MD Department of Orthopaedic Surgery & Rehabilitation Loyola University Medical Center BUY THIS BOOK! Essentials of Musculoskeletal CareMore information
EMG and the Electrodiagnostic Consultation for the Family Physician
EMG and the Electrodiagnostic Consultation for the Family Physician Stephanie Kopey, D.O., P.T. 9/27/15 The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Marketing CommitteeMore information
A B. Week 4. Abdominal Control. Double leg and arm stretch with gym ball
Week 4 Abdominal Control Double leg and arm stretch with gym ball Perform 2 sets 15 on each leg. Find neutral spine and contract LAbs. Assume a position as in the picture A Breathe in-out stretch bothMore information


text:
Wolfgang Amadeus Mozart, a child prodigy who became an adult genius, died in debt and was buried in an unmarked grave in his adopted home of Vienna. Mozart needed no formal lessons in composition. He'd been composing since the age of five, and possessed astonishing musical memory, able to re-create whatever he heard or saw. He could mimic different styles and his travels, which were endless, gave him plenty to imitate whether sacred, dramatic or instrumental. As he said, 'I can pretty well adapt or conform myself to any style or composition.' He was not the tortured artist but could compose whilst playing billiards or skittles, ordering the musical ideas in his head so exactly that writing them down was a slightly mechanical affair, requiring little effort. The music was there in its entirety in his head.
Mozart struggled with relationships, revealing a strong sense of abandonment beneath the surface. Quick to judge, he possessed a sharp manner himself, but saw only the upset that others caused him. He had a long list of foes and his battles with them he describes in much detail. A difficult relationship with his controlling father Leopold was partially offset by a happy marriage to Constanze, a genuine oasis in a world he found frustrating. Mozart was a phenomenal performer as well as composer, enjoying moments of great adulation. But these never turned into financial security. For this reason, he was a reluctant piano teacher throughout his life. 'Conversations with Mozart�� is an imagined conversation with the man behind the music who died largely unnoticed at the age of 35. But while the questions are imagined, Mozart's words are not; they are all authentically his, taken from his many letters. He was the eternal child. As his sister Nanerl said, 'Outside of music he was, and remained, nearly always a child.' But he was a child with a seat at the very top composers' table; a conduit for the most perfectly shaped musical argument, sublime harmonies and with a deep understanding of drama and emotion. 'There's never a dull moment with Wolfgang,' says Simon Parke. 'He's fascinating on the subject of music, and beguiling on the soap opera of his life. He understood music better than he understood himself, which brought suffering. But he was determined to be cheerful. Hope was always round the next corner for Wolfgang.'
©2010 White Crow Productions Ltd (P)2010 White Crow Productions Ltd
There are no reviews for this title yet.
Report Inappropriate Content
If you find this review inappropriate and think it should be removed from our site, let us know. This report will be reviewed by Audible and we will take appropriate action.

subset: commoncrawl


text:
Brisbane to Cairns Experience
About Australia
You can get a sense of just how huge Australia is by looking at a map, but once you're there, the vastness really hits home. For travellers long on ambition but short on time, this extensive and compact journey up the East Coast of Queensland is nothing short of ideal. Employing a diverse range of transport – yachts, trains, 4×4s, and buses – you'll visit Fraser Island and the Whitsundays, go snorkelling and camp out under the stars in an authentic Australian "swag." Your time here may not last long, but your memories will last forever.
What's Included
Fraser Island overnight excursion. Noosa Everglades overnight experience. Entrance fees to Fraser Island in Great Sandy NP. 3-day sailing excursion (Whitsunday Islands). Visit to Whitehaven Beach. G Adventures-supported Ingan Cultural Museum and Jirrbal Aboriginal art demonstration. All transport between destinations and to/from included activities.
Sleep under the stars at a remote cattle station, zip over dunes in a 4×4 on a remote sand island, sail from island to island through the Whitsundays on a maxi yacht
Dossier Disclaimer
The information in this trip details document has been compiled with care and is provided in good faith. However it is subject to change, and does not form part of the contract between the client and the operator. The itinerary featured is correct at time of printing. It may differ slightly to the one in the brochure. Occasionally our itineraries change as we make improvements that stem from past travellers, comments and our own research. Sometimes it can be a small change like adding an extra meal along the itinerary. Sometimes the change may result in us altering the tour for the coming year. Ultimately, our goal is to provide you with the most rewarding experience. Please note that our brochure is usually released in November each year. If you have booked from the previous brochure you may find there have been some changes to the itinerary.
VERY IMPORTANT: Please ensure that you print a final copy of your Trip Details to review a couple of days prior to travel, in case there have been changes that affect your plans.
Itinerary Disclaimer
While it is our intention to adhere to the route described below, there is a certain amount of flexibility built into the itinerary and on occasion it may be necessary, or desirable to make alterations. The itinerary is brief, as we never know exactly where our journey will take us. Due to our style of travel and the regions we visit, travel can be unpredictable. The Trip Details document is a general guide to the tour and region and any mention of specific destinations or wildlife is by no means a guarantee that they will be visited or encountered. Aboard expedition trips visits to research stations depend on final permission.
Additionally, any travel times listed are approximations only and subject to vary due to local circumstances.
Important Notes
This tour combines with other G Adventures tours. As such, the staff and some travel companions on your tour may have previously been traveling together with G Adventures prior to Day 1 of your tour. Likewise, some staff and travel companions may be continuing together on another G Adventures tour after your trip concludes.
Note that only 1 piece of luggage and 1 carry on are allowed on the Queensland train. If you exceed this allowance, AUD15 may be charged upon boarding the train.
Group Leader Description
This G Adventures group trip is accompanied by one of our group leaders, otherwise known as a Chief Experience Officer (CEO). The CEO will be the group manager, leader and driver – this person is experienced in the routes travelled and will organize and lead the meal preparations and has experience in cooking a variety of local and international dishes for large groups.
As the group coordinator and manager, the aim of the CEO is to take the hassle out of your travels and to help you have the best trip possible. While not being guides in the traditional sense, you can expect them to have a broad general knowledge of the countries visited on the trip, including historical, cultural, religious and social aspects. They will also offer suggestions for things to do and to see, recommend great local eating venues and introduce you to our local friends.
We also use local guides where we think more specific knowledge will add to the enjoyment of the places we are visiting – we think it's the best of both worlds.
Group Size Notes
Max 20, avg 16
Eating is a big part of traveling. Travelling with G Adventures you experience the vast array of wonderful food that is available out in the world. Generally meals are not included in the trip price when there is a choice of eating options, to give you the maximum flexibility in deciding where, what and with whom to eat. It also gives you more budgeting flexibility, though generally food is cheap. Our groups tend to eat together to enable you to taste a larger variety of dishes and enjoy each other's company. There is no obligation to do this though. Your CEO will be able to suggest favourite restaurants during your trip. For all trips please refer to the meals included and budget information for included meals and meal budgets.
Please note that most included breakfasts will consist of cereal, milk, bread and spreads, juice, tea and instant coffee. Having a simple breakfast together most days allows us the flexibility to get on the road early and get from point A to B all that much faster.
Private bus, maxi yacht, boat, train, 4×4, ferry
About our Transportation
Our vans are Mini Coaches (24 seat vans which have been accommodated to occupy 18 people so you have more space while travelling). Occasionally with smaller group sizes we will use smaller, equally comfortable 13 seater vehicles. All Mini Coaches tow a trailer for luggage and camping equipment (when needed). All groups have one CEO/Driver.
The vehicles are factory built, with comfortable seats and air-conditioning. They are fitted with seat belts and it is mandatory to wear them.
On the 4×4 based trips we use purpose-built 16 or 13 seat truck vehicles. They have an air-conditioned customer compartment which is fitted with comfortable coach seats. All seats are forward facing.
On the rail based sections of our trips we use a standard seat, not the sleeping compartment. The trains have have a dinning carriage available.
Solo Travellers
We believe solo travellers should not have to pay more to travel so our group trips are designed for shared accommodation and do not involve a single supplement. Single travellers joining group trips are paired in twin or multi-share accommodation with someone of the same sex for the duration of the trip. Some of our Independent trips are designed differently and solo travellers on these itineraries must pay the single trip price.
Hostels (4 nts), cabin (1 nt), tents (1 nt), swag camping (1 nt), maxi yacht (2 nts). All nights multi-share.
About Accommodation
Accommodation will be varied throughout your adventure. When camping on this tour, you will have the choice between a tent (4-person tents) or the truly Aussie 'swag' — a canvas bedroll with built-in padding and perfect for a night under the stars. We'll have both with us, so mix it up and try out the Aussie way. Towels and soap are not always provided at overnight stops, so it's best to bring your own for bathing. Bathroom and showering facilities are shared and are very rarely en-suite.
Multi-share accommodation, on a single-sex basis (typically 4-6 people per room), is very common in Australia and is the way you will be spending most of your nights. We have specifically chosen unique accommodations to give local flavour to your trip.
Couples: Please note that due to the types of accommodation used in Australia, couples will likely be split into separate rooms where we use multi-share hostels. Pending availability, couples may be able to pay extra while on tour to have their own room in some destinations.
Joining Hotel
For details of your joining hotel please refer to your tour voucher, G Account, the G Adventures App or contact your travel agent.
Joining Instructions
By Taxi: Approximately $40, 16km
By Air Train: $15 per person. By far the best option; trains leave the airport every 15-20 minutes. Leave the train at Roma Street Station. Base Brisbane Uptown is opposite Roma St station.
Arrival Complications
We don't expect any problems, and nor should you, but if for any reason you are unable to commence your trip as scheduled, please refer to the emergency contact details provided in this dossier and contact us as soon as possible. If you have a pre-booked transfer, and you have not made contact with our representative within 30 minutes of clearing customs and immigration, we recommend that you make your own way to the Starting Point hotel, following the Joining Instructions. Please apply to your travel agent on your return for a refund of the transfer cost if this occurs.
Emergency Contact
Should you need to contact G Adventures during a situation of dire need, it is best to first call our local office in Melbourne. If for any reason you do not receive an immediate answer, please leave a detailed message and contact information, so we may return your call and assist you as soon as possible.
G Adventures Local Office (Melbourne)
During office hours, 9am-5pm Local Time
From outside Australia: +61 3 9413 5820
From within Australia: 03 9413 5820
After office hours emergency number
From outside Australia: +61 432 705 621
From within Australia: 0432 705 621
If you are unable for any reason to contact our local operations manager, please call the numbers listed below, which will connect you directly with our 24 hour Sales team, who will happily assist you.
Toll-free, North America only: 1 888 800 4100
Calls from UK: 0344 272 0000
Calls from Germany: 0800 365 1000
Calls from Australia: 1 300 796 618
Calls from New Zealand: 0800 333 307
Outside North America, Australia, New Zealand, Germany and the UK: +1 416 260 0999
What to Take
You will be on the move a lot, so our advice is to pack as lightly as possible. We recommend the use of a well-labeled duffel bag, soft bag or backpack (whichever you find easiest to carry). Suitcases or heavy luggage are not recommended for the health of the CEO! A good size day-pack (20-35L) is also essential as you will have the chance to walk and hike in different national parks during these trips. This daypack will be used to carry your personal gear for the day, your lunch and a water bottle.
You will need a smaller bag for the Fraser Island overnight excursion, as we will leave big bags on the mainland due to space constraints.
For days in the outdoors, we recommend the use of lightweight, breathable, moisture-wicking fabrics made of wool or synthetic fibers. Cotton is not recommended for days spent hiking as it does not allow for heat or moisture to enter or escape, and it will not dry easily once wet.
•Passport (with photocopies)
•Travel insurance (with photocopies)
•Airline tickets (with photocopies)
•AUD cash
•Credit or debit card (see personal spending money)
•G Adventures vouchers, pre-departure information and dossier
•Any entry visas or vaccination certificates required
-Weather-appropriate clothing
•Light fleece top
•Light windproof/waterproof jacket
•Sun hat
•Sturdy walking shoes
•Toiletries (biodegradable)
•Watch or alarm clock
•Water bottle
•Money belt
•Flashlight or headlamp
•Camera, memory card(s) and charger
•Electricity plug adapter
•First-aid kit
-Insect Repellent
-Day pack/overnight bag (necessary for Fraser overnight excursion)
-Camera with extra memory cards and batteries
-Personal Entertainment
-Waterproof backpack cover
All countries require a valid passport (with a minimum 6 months validity). Contact your local embassy or consulate for the most up-to-date visa requirements, or see your travel agent. It is your own responsibility to have the correct travel documentation. Visa requirements for your trip will vary depending on where you are from and where you are going. We keep the following information up to date as far as possible, but rules do change and sometimes without warning. While we provide the following information in good faith, it is vital that you check the information yourself and understand that you are fully responsible for your own visa requirements.
A valid passport and visa is required. For some nationalities, the visa can be issued by your Travel Agency or the Australian Embassy via Electronic Travel Authority (ETA).
To apply for an ETA online, travellers must hold a passport from one of the following countries:
- Brunei – Darussalam
- Canada
- Hong Kong
- Japan
- Malaysia
- Singapore
- South Korea
More information about the ETA and how to apply can be found here:
If you do not hold a passport from any of the above countries, you cannot apply for an ETA online. You may be eligible to apply for an ETA through a travel agent, airline or an Australian visa office. Alternatively, you may be eligible to apply for other types of electronic visitor visas. See: www.immi.gov.au
Spending Money
Every traveller is different and therefore spending money requirements will vary. Some travellers may drink more than others while other travellers like to purchase more souvenirs than most. Please consider your own spending habits when it comes to allowing for drinks, shopping and tipping. Please also remember the following specific recommendations when planning your trip.
Money Exchange
The Australian currency is the Australian Dollar (AUD).
Credit cards are accepted almost everywhere in Australia and can be used to purchase small and large items. When purchasing products or services with a foreign credit card you may be charged additional fees by your credit card company for foreign purchases.
Credit cards and debit cards are very useful for cash advances but you must remember to bring your PIN number (be aware that many ATM machines only accept 4-digit PINs). Both Cirrus and Plus system cards are the most widely accepted debit cards. Both Visa and Master Cards are the most widely accepted credit cards. While ATMs are commonly available, there are no guarantees that your credit or debit cards will actually work check with your bank before you travel. A visit to an ATM can be arranged on Day 1 and other days of the trip.
Do not rely on credit or debit cards as your only source of money. A combination of local currency (preferably smaller bills, 5's, 10's and 20's), traveller's cheques and credit cards is best. Currency exchange is best obtained prior to travel or at the airport, currency exchange is easy to find in Australia in the gateway cities and most banks do accommodate.
Always take more rather than less, as you don't want to spoil the trip by constantly feeling short of funds.
As currency exchange rates can fluctuate often we ask that you refer to the following website for daily exchange rates: www.xe.com
Emergency Fund
Please also make sure you have access to at least an additional USD $200 (or equivalent) as an 'emergency' fund, to be used when circumstances outside our control (ex. a natural disaster) require a change to our planned route. This is a rare occurrence!
It is not customary in New Zealand or Australia to tip service providers, but if you do experience outstanding service it is good to do so. Such service would only usually be in places like quality restaurants and it would be very rare that you would tip more than 10%. Unless specifically asked to do so at the time (by your CEO) – do not tip your local guides. Also at the end of each trip if you felt your G Adventures Chief Experience Officer did an outstanding job, you may consider a small tip – but it certainly isn't expected.
Optional Activities
All prices are per person, in AUD amounts and are subject to change as services are provided by third party operators. Please note there may be weight restrictions on certain activities (eg skydiving 100 – 110 kg).
Fraser Island Flight $75
Scuba Diving $75
Whitewater Rafting $195 (Tully Full-day) $225 (Xtreme Tully Full-day)
Bungee jumping $169 (includes certificate and t-shirt)
Minjin Swing $99
Combo Bungee and Minjin Swing $319
Safety and Security
Many national governments provide a regularly updated advice service on safety issues involved with international travel. We recommend that you check your government's advice for their latest travel information before departure. We strongly recommend the use of a neck wallet or money belt while travelling, for the safe keeping of your passport, air tickets, travellers' cheques, cash and other valuable items. Leave your valuable jewelery at home – you won't need it while travelling. Many of the hotels we use have safety deposit boxes, which is the most secure way of storing your valuables. A lock is recommended for securing your luggage. When travelling on a group trip, please note that your group leader has the authority to amend or cancel any part of the trip itinerary if it deemed necessary, due to safety concerns. Your Chief Experience Officer (CEO) will accompany you on all included activities. During your trip you will have some free time to pursue your own interests, relax and take it easy and explore at your leisure. While your CEO will assist you with options available in a given location, please note that any optional activities you undertake are not part of your itinerary, and we offer no representations about the safety of the activity or the standard of the operators running them. Please use your own good judgement when selecting an activity in your free time. Although the cities visited on tour are generally safe during the day, there can be risks to wandering throughout any major city at night. It is our recommendation to stay in small groups and to take taxis to and from restaurants, or during night time excursions.
Water based activities have an element of danger and excitement built into them. We recommend only participating in water based activities when accompanied by a guide(s). We make every reasonable effort to ensure the fun and adventurous element of any water based activities (in countries with varying degrees of operating standards), have a balanced approach to safety. It is our policy not to allow our CEOs to make arrangements on your behalf for water based activities that are not accompanied by guide(s).
Swimming, including snorkeling, is always at your own risk. Read more about travel safety for ways to further enhance your personal safety while traveling.
Medical Form
Our small group adventures bring together people of all ages. It is very important you are aware that, as a minimum, an average level of fitness and mobility' is required to undertake our easiest programs. Travellers must be able to walk without the aid of another person, climb 3-4 flights of stairs, step on and off small boats, and carry their own luggage at a minimum. Travellers with a pre-existing medical condition are required to complete a short medical questionnaire, which must be signed by their physician. This is to ensure that travellers have the necessary fitness and mobility to comfortably complete their chosen trip. While our CEOs work hard to ensure that all our travellers are catered for equally, it is not their responsibility to help individuals who cannot complete the day's activities unaided. Please refer to the physical ratings in this Trip Details document for more information.
The medical questionnaire can be found online at:
A Couple of Rules
Illegal drugs will not be tolerated on any trips. Possessing or using drugs not only contravenes the laws of the land but also puts the rest of the group at risk. Smoking marijuana and opium is a part of local culture in some parts of the world but is not acceptable for our travellers. Our philosophy of travel is one of respect towards everyone we encounter, and in particular the local people who make the world the special place it is. The exploitation of prostitutes is completely contrary to this philosophy. Our group leader has the right to expel any member of the group if drugs are found in their possession or if they use prostitutes.
Travel Insurance
Travel insurance is compulsory in order to participate on any of our trips. When travelling on a group trip, you will not be permitted to join the group until evidence of travel insurance has been sighted by your leader, who will take note of your insurance details. When selecting a travel insurance policy we require that at a minimum you are covered for medical expenses including emergency evacuation and repatriation. A minimum coverage of USD200,000 is required. G Adventures can provide you with the appropriate coverage. We strongly recommend that the policy also covers personal liability, cancellation, curtailment and loss of luggage and personal effects. If you have credit card insurance we require proof of purchase of the trip (a receipt of credit card statement) with a credit card in your name. Contact your bank for details of their participating insurer, the level of coverage and emergency contact telephone number.
Planeterra-The G Adventures Foundation
Planeterra is G Adventures' non-profit foundation created to make a positive difference in the communities where G Adventures takes travellers. Planeterra supports sustainable social and environmental solutions in destinations travellers love to visit.
As travellers, it's natural to want to give back to the places we've come to love. But to truly impact poverty, we work to build self-sufficiency, not dependency.
Planeterra partners with grassroots organizations with firsthand knowledge of local culture and true community needs. This ensures that solutions come from the people we support. Then G Adventures brings travellers to visit, fuelling sustainable local income in these communities. This model is helping many rural and marginalized communities on their way to self-sufficiency because they are harnessing the power of the tourism industry as a force for good. G Adventures matches all individual donations and pays all administration costs, which means that 100% of each donation is doubled and goes directly to support our projects. For more information about Planeterra and the projects we support, or to make a donation, please visit planeterra.org.
Fifty percent of our planet lives on less than $2/day. For the price of a coffee, you can make every day of your trip count by giving back to the communities you visit through Planeterra.
To participate in this program please indicate at the time of booking that you would like to participate in G Adventures' Dollar-A-Day program, either by clicking the check box online, or by advising your G Adventures specialist or travel agent. (Note: Donation will be charged in the currency of your booking).
After your travels, we want to hear from you! Your feedback information is so important to us that we'll give you 5% off the price of your next G Adventures trip if your feedback is completed on-line within 30 days of finishing your trip. Your tour evaluation will be e-mailed to you 24 hours after the conclusion of your trip. If you do not receive the tour evaluation link in the days after your tour has finished, please drop us a line at email@example.com and we will send it on to you.
Our adventure travel e-newsletter is full of travel news, trip information, interesting stories and contests. To avoid missing out on special offers and updates from G Adventures, subscribe at www.gadventures.com/newsletters/
Stay current on how our company invests in our global community through our foundation – Planeterra. Sign up for Planeterra's monthly news to learn more about how to give back and support the people and places we love to visit.
Travel Forum - The Watering Hole
Be sure to stop by The Watering Hole, our adventure travel forum. If you're interested in meeting others booked on your upcoming trip, check out the Departure Lounge section of our forum and introduce yourself. Otherwise, just drop in at anytime to share some travel tips, ask questions, meet other travellers and quench your thirst for travel. Our forum is located at wateringhole.gadventures.com.
Itinerary Notes
Please note that most Yolo accommodation in Australia is multi-share. For more info, see our Trip Details.
Max Pax
Group Leader
Chief Experience Officer (CEO) throughout, local guides.
Meal Budget
Allow USD170-225 for meals not included.
Meals Included
8 breakfasts, 4 lunches, 4 dinners
Terms, conditions and restrictions apply; pricing, availability, and other details subject to change and/ or apply to US or Canadian residents. Please confirm details and booking information with your travel advisor.
Day 1 Brisbane
Arrive in Brisbane at any time. There are no planned activities during the day, so check into the hotel and explore the city.
If you arrive early enough, you'll have time to head into the city to visit City Hall, the Treasury Building or relax on Streets Beach.
Included Activities:
Arrival Day and Welcome Meeting
Day 2 Fraser Island (1B, 1L)
Once on the island, enjoy a 4×4 tour of Fraser Island, driving along over 100km of beach. Go for a swim in Lake McKenzie, and enjoy a rainforest walk along the way.
Additional Notes:
While on Fraser Island and the Noosa Everglades, main luggage will be stored in a secure storage facility. Each person will need to pack a bag for two nights with max weight of 5kg. This is due to luggage capacity restrictions in 4×4 vehicles and canoes. Your CEO will explain further details on arrival into Rainbow Beach.
Depending on the day of the week, some groups may swap the order of the Fraser Island and Noosa Everglades days. Some groups will first travel to the Noosa Everglades for a night before travelling on to Fraser Island. All inclusions will still be offered but just in a different order.
Private Vehicle (5.00 hour(s), 250km)
Day 3 Fraser Island/Noosa River (1B, 1L, 1D)
Enjoy a morning of exploring by 4×4 to hit the remainder of Fraser Island's highlights, then set off to the Noosa Everglades. Canoe upstream to a riverside camp for an evening surrounded by stunning wilderness.
Included Activities:
4×4 Excursion
Noosa Everglades Overnight Excursion
Day 4 Rockhampton (1B, 1D)
Catch a train up the 'Capricorn Coast' which is well-known as 'Cattle Country'. Arrive at a remote farm and stay the night. The workers from the property are excellent hosts as they teach about the history of the farm, the cattle industry, and some of the challenges of raising cattle in such a harsh environment.
Train (6.00-8.00 hours)
Day 5 Whitsunday Islands Sailing (1B, 1D)
After a traditional Outback-style breakfast, transfer to the town of Airlie Beach and embark on a maxi yacht which will be our home for the next three days. Set sail to a secluded cove in the Whitsunday Islands where you will drop anchor for the night.
Included Activities:
Whitsunday Islands Yolo Sailing Trip, Day 1
Private Vehicle (6.50-7.00 hours, 539km)
Maxi yacht
Day 6 Whitsunday Islands (1B, 1L, 1D)
The sailing route today allows us to follow part of Captain Cook's route up through the Whitsunday Islands. There is the option for certified divers to scuba dive. Again we drop anchor in a secluded bay for the night.
Included Activities:
Whitsunday Islands Yolo Sailing Trip, Day 2
Maxi yacht
Day 7 Whitsundays/Whitehaven Beach/Airlie Beach (1B)
After three days at sea, we sail to the resort town of Airlie Beach for a night on land in a local beach hostel resort. Feel free to relax by the pool at the end of the day.
Included Activities:
Whitsunday Islands Yolo Sailing Trip, Day 3
Maxi yacht
Day 8 Cairns (1L)
Admire the scenery on the train north to Tully. Upon arrival, enjoy lunch and a tour of the G Adventures-supported Ingan Cultural Museum. Participate in either a weaving or painting activity with traditional Jirrbal Aboriginal artists before continuing on to Cairns.
Included Activities:
Ingan Cultural Museum & Jirrbal Aboriginal Art Demonstration
Train (5.00 hour(s), 482km)
Private Vehicle (2.00 hour(s), 140km)
Day 9 Cairns (1B)
Enjoy a free day to visit the Great Barrier Reef or get the adrenaline pumping by skydiving, whitewater rafting or bungee jumping.
Day 10 Cairns (1B)
Depart at any time.
Included Activities:
Departure Day


text:
|[innisfree ( Innisfree ):
|Product name
|Green tea pure lotion green tea pure lotion
|Content amount
|160 ml
|Product description
| Jeju organic 農グ Lee and tea components from the back of the skin moist to moisture lotion
-The painted soft, fast absorption, べたつかなくて and makes your skin smooth.
-Jeju organic 農グ Lynn-draws moisture an immiscible tea ingredients containing water in the skin moisturized and protect organic agriculture Marshmallow ingredient supplies nutrition to skin, help to soften.
-Green tea grows at Jeju Island clean, Brassica, mandarin oranges, glazed complex containing 100 years the grass and volcanic rock water composition.
[How to use]
After washing your face, take an appropriate amount and apply easy to absorb the drops to the face and neck.
The グリーンティーシードセラム グリーンティーピュア skins → → lotion cream → deep cream → eye → sleeping Pack → ミネラルミスト
|Country of manufacture
|Skin care and intensive care
|Ads responsibility
| MAW Ltd.
06-6251-3316 (Contact phone number)
Start Date:03/07/2017 00:00 JST
End Date:30/09/2017 23:59 JST
This product cannot be shipped to United States from the store.
Please contact the store for further information.


text:
This time around, I decided to do the tissue paper with a much younger group, 1st grade. Instead of doing individual stain glass pieces, we worked as a table group to make one large piece that would be cut apart.This is where multiple layers is best, cutting into the tissue is much easier if it is thick, especially for the younger grade levels.
Thursday, March 16, 2017
Winter Scene
This is one of those happy accidents that I discovered years ago, early in my teaching days. Someone had accidentally left the laminator rolling. Yep, the whole roll went through the laminator. Luckily it wasn't a brand new roll. But still, we all know how valuable the laminator is and once we run out of lamination for the year...that's it.
Sunday, February 5, 2017
Insects: Up Close
Saturday, January 28, 2017
Just Keep Swimming
This is a project that I do with 3rd graders. Years ago when I would do the Original Works program at my last school, this is the piece that I would have done with my 3rd graders. Of course, it has evolved and changed over the years, but I feel like I get great results from it each time.
Subscribe to: Posts (Atom)