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MacRae S.1,2, Critchley D.3, Lewis J.4,5, Shortland A.6,7
1Chelsea and Westminster Hospital NHS Foundation Trust, Therapy Services, London, United Kingdom, 2Brunel University, Department of Clinical Sciences, London, United Kingdom, 3King's College London, Academic Department of Physiotherapy & Division of Health and Social Care Research, London, United Kingdom, 4University of Hertfordshire, Department of Allied Health Professions, Hatfield, United Kingdom, 5Central London Community Healthcare NHS Foundation Trust, Musculoskeletal Services, London, United Kingdom, 6Guy's and St Thomas' NHS Foundation Trust, One Small Step Gait Laboratory, London, United Kingdom, 7King's College London, Biomedical Engineering, London, United Kingdom
Background: Differences in postural control and gait have been identified between people with and without chronic low back pain (CLBP). These differences in postural control and gait have been proposed as contributing factors to the presence and recurrent nature of CLBP. However, there are methodological concerns in many of these studies, including: small sample sizes; issues relating to reliability; and results not representative of the general population. Evidence from fewer studies, many with larger sample sizes and more robust methodologies demonstrate no difference between groups. Hence, whether a true difference exists in postural control and kinetic, kinematic and spatiotemporal parameters of gait between people with and without CLBP remains unclear.
Purpose: This research aimed to add to current clinical knowledge by utilising a robust, reliable methodology to determine whether participants with CLBP have similar or different barefoot standing postural control, and gait parameters, when compared with age- and gender-matched asymptomatic participants. This study hypothesised there would be a difference in standing postural control, and kinetic, kinematic and spatiotemporal parameters of gait in people with CLBP compared to people without.
Methods: This cross-sectional study age- (+/- 2 years) and gender- matched 16 people with CLBP and 16 asymptomatic participants. Participants were assessed barefoot: i) standing, over three 40 second trials, under four posture challenging conditions (firm surface, eyes-open; firm surface, eyes-closed; compliant surface, eyes-open; compliant surface, eyes-closed); ii) during gait. Primary outcome was postural stability (assessed by root mean squared error of centre of pressure (CoP) displacement (CoPRMSEAP) and mean CoP velocity (CoPVELAP), both in the antero-posterior direction); gait outcomes were sagittal plane hip range of movement and peak hip moments, walking speed, cadence, and stride length, assessed using force plates and a motion analysis system. Force plate data (forces and moments) captured at 1080 Hz and filtered with a low pass Woltering filter (mean standard error 10mm2) were exported into Vicons Nexus software (1.8.1) to calculate biomechanical outcome measures.
Results: All 32 participants completed the data collection process. There were no differences between the groups in CoPRMSEAP (p=0.26), or CoPVELAP (p=0.60) for any standing condition. During gait, no differences were observed between groups for spatio-temporal parameters, maximum, minimum and total ranges of movement at the hip, or peak hip flexor or extensor moments in the sagittal plane.
Conclusion(s): In contrast to previous research, this study suggests that people with mild to moderate CLBP present with similar standing postural control, and parameters of gait to asymptomatic individuals.
Implications: Based on the findings of this study, clinicians should feel confident that standing postural stability, kinetic, kinematic and spatio-temporal parameters of gait do not differ in people with and without mild to moderate CLBP, Furthermore, treatments directed at influencing postural stability (for example, standing on a wobble board) or specific parameters of gait may be an unnecessary addition to a treatment programme.
Funding acknowledgements: The clinical study from which CLBP participants were recruited was funded by a Masai GB Limited. project grant.
Topic: Musculoskeletal: spine
Ethics approval: Outer North London Research Ethics Committee [REC: 10/H0724/7] and Kings College London Research Ethics Subcommittee [BDM/10/11-7]
All authors, affiliations and abstracts have been published as submitted.
