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Peer-reviewedCC BYPLOS One

Dissociation between muscle activation, spinal joint load, and subjective perception in passive back support exoskeleton use

  • Hyeonhee Jung1
  • Jangwhan Ahn2,3
  • Eunsik Choi4
  • Jeongin Moon5
  • Kyoungchul Kong6,7
  • Jooeun Ahn4,8,9
9 affiliations
  1. 1Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea.
  2. 2The Lampe Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, United States of America.
  3. 3The Lampe Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
  4. 4Department of Physical Education, Seoul National University, Seoul, Republic of Korea.
  5. 5Department of Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America.
  6. 6Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
  7. 7Angel Robotics Co, Ltd, Seoul, Republic of Korea.
  8. 8Institute of Sport Science, Seoul National University, Seoul, Republic of Korea.
  9. 9SNU Robotics Institute, Seoul National University, Seoul, Republic of Korea.
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Abstract

One important purpose of back support exoskeletons (BSEs) is to reduce the stress to the lumbar spine and alleviate the low back pain. However, most previous studies introducing BSEs have argued for their effectiveness based only on easily measurable physiological outcomes such as muscle activation. Motivated by this gap, we examined whether the muscle activation of the back muscle during load handling with a passive BSE can faithfully reflect the estimated L5–S1 joint reaction forces and subjective perceptions. Experiments involving 12 healthy young adults revealed that the BSE significantly reduced average thoracic erector spinae muscle activation during both lifting and lowering the load, and lumbar erector spinae muscle activation during lowering. The BSE also reduced integrated thoracic erector spinae muscle activation during lowering. L5–S1 joint reaction forces were also significantly reduced by the BSE (p < 0.001). Participants reported a lower rate of perceived exertion (p < 0.05). However, the lack of associations among all metrics suggests that inferring one measure from another remains limited when evaluating the efficacy of a BSE.

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Cite

BibTeXRIS
BibTeX
@article{jung2026dissociation,
  title = {{Dissociation between muscle activation, spinal joint load, and subjective perception in passive back support exoskeleton use}},
  author = {Hyeonhee Jung and Jangwhan Ahn and Eunsik Choi and Jeongin Moon and Kyoungchul Kong and Jooeun Ahn},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0361338},
  url = {https://doi.org/10.1371/journal.pone.0361338},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Dissociation between muscle activation, spinal joint load, and subjective perception in passive back support exoskeleton use
AU  - Hyeonhee Jung
AU  - Jangwhan Ahn
AU  - Eunsik Choi
AU  - Jeongin Moon
AU  - Kyoungchul Kong
AU  - Jooeun Ahn
PY  - 2026
DA  - 2026/10/26
JO  - PLOS One
DO  - 10.1371/journal.pone.0361338
UR  - https://doi.org/10.1371/journal.pone.0361338
AB  - One important purpose of back support exoskeletons (BSEs) is to reduce the stress to the lumbar spine and alleviate the low back pain. However, most previous studies introducing BSEs have argued for their effectiveness based only on easily measurable physiological outcomes such as muscle activation. Motivated by this gap, we examined whether the muscle activation of the back muscle during load handling with a passive BSE can faithfully reflect the estimated L5–S1 joint reaction forces and subjective perceptions. Experiments involving 12 healthy young adults revealed that the BSE significantly reduced average thoracic erector spinae muscle activation during both lifting and lowering the load, and lumbar erector spinae muscle activation during lowering. The BSE also reduced integrated thoracic erector spinae muscle activation during lowering. L5–S1 joint reaction forces were also significantly reduced by the BSE (p < 0.001). Participants reported a lower rate of perceived exertion (p < 0.05). However, the lack of associations among all metrics suggests that inferring one measure from another remains limited when evaluating the efficacy of a BSE.
SN  - 1932-6203
ER  -