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Christe G1,2, Jolles B2,3, Favre J2
1HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Department of Physiotherapy, Lausanne, Switzerland, 2Lausanne University Hospital and University of Lausanne, Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne, Switzerland, 3Ecole Polytechnique Fédérale de Lausanne, Institute of Microengineering, Lausanne, Switzerland
Background: Alterations in spinal kinematics has been repeatedly reported in patients with chronic low back pain (CLBP). Nevertheless, the importance of these alterations in CLBP pathomechanisms is still not well understood. Recent research highlighted the need to better understand spinal kinematics during daily-life activities, and to do so using multi-segment biomechanical models. Stepping-up is a particularly relevant daily-life activity in this regard because it is frequent, demanding and often associated with CLBP.
Purpose: To characterize the angle patterns at the lower lumbar (LLS), upper lumbar (ULS), lower thoracic (LTS) and upper thoracic (UTS) joints during stepping-up at three different heights and to compare spinal kinematics between people with and without CLBP.
Methods: Spinal kinematics of 10 patients with non-specific CLBP and 11 pain-free individuals matched for age, sex and BMI (6 males; 37.7±5.9 years old; 22.3±2.7 kg/m^2) was collected in a laboratory with a three dimensional camera-based system (VICON, UK) using a previously described multi-segment biomechanical model.
Results: Characteristic patterns of movement were identified at the four joints in the sagittal plane and at the ULS and LTS joints in the frontal plane, therefore allowing the analysis of these angle patterns through characteristic peak angle measures. Measurement reliability for the peak measures was good to excellent at three step heights with median [IQR] ICC of 0.85-0.92 [0.80 to 0.96] and median SEM of 0.84°-1.19° [0.61 to 1.56]. The peak flexion angle, sagittal-plane ranges of motion (ROM) and frontal-plane initial ROM at the ULS were significantly smaller in the patient group with the medium-height and higher steps (-32% to -65%, p 0.05). Both groups also significantly differed in the peak LLS extension angle at the end of stepping up on the highest step, with smaller extension in patients with CLBP (-0.42° [-1.48 to 2.71]) compared to controls (5.79° [0.87 to 7.96]; p 0.05). Small, but significant differences in thoracic kinematics (LTS and UTS) were also observed with the three step heights in the sagittal and frontal planes (p 0.05).
Conclusion(s): During stepping-up, patients demonstrated a large decrease in flexion and lateral bending at the ULS during the first half of stepping up. The UTS was also maintained in a more extended position during the whole task. Additionally, this study showed the importance of the step height, with higher steps detecting larger numbers of differences and differences of larger magnitudes between both groups. Further research should assess the changes in regional spinal kinematics during functional activities over time to determine the potential role of these variables on pain and disability.
Implications: This study provided additional evidence that patients with CLBP move with a more rigid spine during functional movements, which may adversely affect muscle activity and symptoms. These results suggest that rehabilitation should aim for more lumbar and thoracic movements during daily-life activities, accounting for regional and plane of motion specificities. Conversely, stabilization exercises that favour a neutral spine during dynamic functional tasks are not supported by this study as they might increase the rigidity of the trunk observed in patients with CLBP.
Keywords: low back pain, movement, multi-segment
Funding acknowledgements: This study was not funded.
Purpose: To characterize the angle patterns at the lower lumbar (LLS), upper lumbar (ULS), lower thoracic (LTS) and upper thoracic (UTS) joints during stepping-up at three different heights and to compare spinal kinematics between people with and without CLBP.
Methods: Spinal kinematics of 10 patients with non-specific CLBP and 11 pain-free individuals matched for age, sex and BMI (6 males; 37.7±5.9 years old; 22.3±2.7 kg/m^2) was collected in a laboratory with a three dimensional camera-based system (VICON, UK) using a previously described multi-segment biomechanical model.
Results: Characteristic patterns of movement were identified at the four joints in the sagittal plane and at the ULS and LTS joints in the frontal plane, therefore allowing the analysis of these angle patterns through characteristic peak angle measures. Measurement reliability for the peak measures was good to excellent at three step heights with median [IQR] ICC of 0.85-0.92 [0.80 to 0.96] and median SEM of 0.84°-1.19° [0.61 to 1.56]. The peak flexion angle, sagittal-plane ranges of motion (ROM) and frontal-plane initial ROM at the ULS were significantly smaller in the patient group with the medium-height and higher steps (-32% to -65%, p 0.05). Both groups also significantly differed in the peak LLS extension angle at the end of stepping up on the highest step, with smaller extension in patients with CLBP (-0.42° [-1.48 to 2.71]) compared to controls (5.79° [0.87 to 7.96]; p 0.05). Small, but significant differences in thoracic kinematics (LTS and UTS) were also observed with the three step heights in the sagittal and frontal planes (p 0.05).
Conclusion(s): During stepping-up, patients demonstrated a large decrease in flexion and lateral bending at the ULS during the first half of stepping up. The UTS was also maintained in a more extended position during the whole task. Additionally, this study showed the importance of the step height, with higher steps detecting larger numbers of differences and differences of larger magnitudes between both groups. Further research should assess the changes in regional spinal kinematics during functional activities over time to determine the potential role of these variables on pain and disability.
Implications: This study provided additional evidence that patients with CLBP move with a more rigid spine during functional movements, which may adversely affect muscle activity and symptoms. These results suggest that rehabilitation should aim for more lumbar and thoracic movements during daily-life activities, accounting for regional and plane of motion specificities. Conversely, stabilization exercises that favour a neutral spine during dynamic functional tasks are not supported by this study as they might increase the rigidity of the trunk observed in patients with CLBP.
Keywords: low back pain, movement, multi-segment
Funding acknowledgements: This study was not funded.
Topic: Musculoskeletal: spine; Human movement analysis
Ethics approval required: Yes
Institution: Swiss Ethics
Ethics committee: Commission cantonale d'éthique de la recherche sur l'être humain VAUD
Ethics number: 340/14
All authors, affiliations and abstracts have been published as submitted.
