Lumbar spine kinematics during walking in people with and people without low back pain.

Low back pain (LBP) is a problem that can contribute to functional limitations and disability. Understanding kinematics during walking can provide a basis for examination and treatment in people with LBP. Prior research related to kinematics during walking is conflicting. However, investigators have not considered regional differences in lumbar spine kinematics or movement-based LBP subgroups. In the current study, three-dimensional kinematics of the upper and lower lumbar regions were examined in people with and without LBP. A clinical examination then was conducted to assign people with LBP to a movement-based subgroup and differences in kinematics among subgroups were examined. All subjects displayed significantly more upper than lower lumbar movement in the axial and coronal planes (P<.01). People with LBP displayed significantly less overall lumbar rotation than controls (P<.05). There were no significant group differences in sagittal plane kinematics (P>.05). Walking was limited by or provocative of pain in <25% of subjects with LBP. There were predictable differences in kinematics among some movement-based LBP subgroups that approached statistical significance (P=.09-.11). Walking was provocative of LBP in few subjects, and differences between people with and without LBP and among LBP subgroups were minimal. Limitations include that attempts to standardize gait speed may have minimized observed effects, and there was limited power to detect movement-based LBP subgroup differences.

[1]  S. Sahrmann,et al.  The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. , 2003, Archives of physical medicine and rehabilitation.

[2]  R. Deyo,et al.  Physician Office Visits for Low Back Pain: Frequency, Clinical Evaluation, and Treatment Patterns From a U.S. National Survey , 1995, Spine.

[3]  G. Waddell,et al.  A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability , 1993, Pain.

[4]  J. Steele,et al.  Lumbar kinematic variability during gait in chronic low back pain and associations with pain, disability and isolated lumbar extension strength. , 2014, Clinical biomechanics.

[5]  Peter J Beek,et al.  Journal of Neuroengineering and Rehabilitation Effects of Attention on the Control of Locomotion in Individuals with Chronic Low Back Pain , 2008 .

[6]  Reinhard Blickhan,et al.  Low back pain affects trunk as well as lower limb movements during walking and running. , 2015, Journal of biomechanics.

[7]  L. Straker,et al.  Discriminating Healthy Controls and Two Clinical Subgroups of Nonspecific Chronic Low Back Pain Patients Using Trunk Muscle Activation and Lumbosacral Kinematics of Postures and Movements: A Statistical Classification Model , 2009, Spine.

[8]  John D. Childs,et al.  Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. , 2008, The Journal of orthopaedic and sports physical therapy.

[9]  Raymond Y. W. Lee,et al.  Symptomatic and Asymptomatic Movement Coordination of the Lumbar Spine and Hip During an Everyday Activity , 2005, Spine.

[10]  L. Straker,et al.  Regional differences in lumbar spinal posture and the influence of low back pain , 2008, BMC musculoskeletal disorders.

[11]  Paul W Hodges,et al.  Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey , 2012, BMC Musculoskeletal Disorders.

[12]  J. Fritz,et al.  A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. , 2001, Physical therapy.

[13]  A. Daffertshofer,et al.  Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control , 2006, European Spine Journal.

[14]  J H van Dieën,et al.  Mechanical coupling between transverse plane pelvis and thorax rotations during gait is higher in people with low back pain. , 2012, Journal of biomechanics.

[15]  Leendert Schaake,et al.  Back Muscle Activation Patterns in Chronic Low Back Pain During Walking: A “Guarding” Hypothesis , 2010, The Clinical journal of pain.

[16]  P. O'Sullivan,et al.  Upper and lower lumbar segments move differently during sit-to-stand. , 2013, Manual therapy.

[17]  M. Harris-Hayes,et al.  The Inter‐Tester Reliability of Physical Therapists Classifying Low Back Pain Problems Based on the Movement System Impairment Classification System , 2009, PM & R : the journal of injury, function, and rehabilitation.

[18]  J S Higginson,et al.  Two simple methods for determining gait events during treadmill and overground walking using kinematic data. , 2008, Gait & posture.

[19]  S. Sahrmann,et al.  Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain. , 2007, Archives of physical medicine and rehabilitation.

[20]  M. Levin,et al.  Pelvis-Thorax Coordination in the Transverse Plane During Walking in Persons With Nonspecific Low Back Pain , 2002, Spine.

[21]  Jack Crosbie,et al.  Coordination of Spinal Motion in the Transverse and Frontal Planes During Walking in People With and Without Recurrent Low Back Pain , 2013, Spine.

[22]  Winfried Banzer,et al.  Influences of Nonspecific Low Back Pain on Three-Dimensional Lumbar Spine Kinematics in Locomotion , 2001, Spine.

[23]  J. Hamill,et al.  Influence of Low Back Pain Status on Pelvis-Trunk Coordination During Walking and Running , 2011, Spine.

[24]  P. Hodges,et al.  Changes in three dimensional lumbo-pelvic kinematics and trunk muscle activity with speed and mode of locomotion. , 2005, Clinical biomechanics.

[25]  G. Andersson.  Epidemiological features of chronic low-back pain , 1999, The Lancet.

[26]  Jack R Engsberg,et al.  Patterns of Lumbar Region Movement During Trunk Lateral Bending in 2 Subgroups of People With Low Back Pain , 2007, Physical Therapy.

[27]  S. Sahrmann,et al.  Reliability of physical examination items used for classification of patients with low back pain. , 1998, Physical therapy.

[28]  H. Yoshikawa,et al.  Kinematics of the lumbar spine in trunk rotation: in vivo three-dimensional analysis using magnetic resonance imaging , 2007, European Spine Journal.