Spinal Kinematics During the Performance of A Dynamic Balance Task In A Sub-Group Of Individuals With Nonspecific Chronic Low-Back Pain

Everett Lohman, Noha Daher, Mansoor Alameri, Amjad Shallan, Faris Alshammari, Robert Dudley
Purpose:

The aim of this study was to compare spinal kinematics between NSCLBP subgroups and healthy individuals during dynamic balance using a modified Star Excursion Balance Test (mSEBT).

Methods:

Eighteen NSCLBP subjects (9 active extension pattern (AEP), 9 flexion pattern (FP)), and 10 healthy controls were enrolled in this study. All subjects performed mSEBT in the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions. Normalized reach distance and the pelvic, lumbar, and thoracic 3-dimensional kinematics were recorded.  

Results:

There were significant differences in mean reach distance in both PL and PM directions between AEP and healthy and between FP and healthy subjects. However, there was no significant difference among the three groups in the anterior reach direction. Kinematic results showed a significant difference in the lumbar spine region between pooled NSCLBP and healthy subjects in all reach directions. However, after the classification of subjects with NSCLBP into AEP and FP subgroups, the results showed significant differences in both lumbar and thoracic spine regions between AEP and FP and between AEP and healthy in all reaching directions. However, there were no significant differences in spinal kinematics between FP and healthy subjects. 

Conclusion(s):

Individuals with AEP and FP experience diminished dynamic balance compared to healthy controls. The thoracic and lumbar spine regions are very important to discriminate between AEP and FP, and between AEP and healthy during dynamic balance. In addition, the findings of this study support the concept of the Multidimensional Classification System (MDCS).

Implications:

The findings of this study highlight the heterogeneity of the subjects with NSCLBP and the importance of identifying the homogenous subgroups in order to provide the best examination and treatment protocols. In addition, the results of this study showed that the reaching distance alone is not enough to show the whole picture of the postural control deficits in NSCLBP subgroups. It is important to examine other variables such as pelvis and spinal kinematics in order to identify the postural control deficits in MCI subgroups. This study also confirmed that subjects with motor control impairment have a maladaptive movement behavior in the thoracic spine region during dynamic balance task. Therefore, we recommended the health care providers to incorporate a thoracic spine movement examination during dynamic balance test.

Funding acknowledgements:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Keywords:
Dynamic balance
Non-specific low back pain
Kinematics
Primary topic:
Musculoskeletal: spine
Second topic:
Orthopaedics
Third topic:
Sport and sports injuries
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
All procedures and protocols of the study were approved by the Institutional Review Board at Loma Linda University . California, USA
Provide the ethics approval number:
518030
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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