Low back pain affects trunk as well as lower limb movements during walking and running.

Up to now, most gait analyses on low back pain concentrate on changes in trunk coordination during walking on a treadmill. Locomotion on uneven ground as well as lower limb changes receives little attention in association with low back pain. The present study focuses on how chronic non-specific low back pain causes modifications in lower limb and trunk movements, in level and uneven walking and running. We found that trunk as well as lower limb movement was influenced by chronic non-specific low back pain. A consistent finding across all gaits and ground level changes is that patients with chronic non-specific low back pain show less pelvis and unchanged thorax rotation as compared to healthy controls. Furthermore, in chronic non-specific low back pain patients the trunk rotation decreased only during level and uneven running whereas the sagittal trunk inclination at touchdown increased only during uneven walking as compared to healthy controls. Besides significant changes in the upper body, in chronic non-specific low back pain patients the knee joint angle at touchdown was more extended during level walking but also during uneven walking and running as compared to healthy controls. We assume that trunk movements interact with lower limb movements or vice versa. Therefore, we recommend that further investigations on low back pain should consider both trunk (primarily pelvis) and lower limb (primarily knee) movements.

[1]  Joseph Hamill,et al.  Low back pain status affects pelvis-trunk coordination and variability during walking and running. , 2011, Clinical biomechanics.

[2]  Reinhard Blickhan,et al.  Kinetic and kinematic adjustments during perturbed walking across visible and camouflaged drops in ground level. , 2014, Journal of biomechanics.

[3]  Stefania Fatone,et al.  The effect of trunk flexion on able-bodied gait. , 2008, Gait & posture.

[4]  Johan S Rietman,et al.  Lumbar and abdominal muscle activity during walking in subjects with chronic low back pain: support of the "guarding" hypothesis? , 2010, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[5]  Geoffrey T Desmoulin,et al.  Comparison of 3D spinal motions during stair-climbing between individuals with and without low back pain. , 2011, Gait & posture.

[6]  H. Hermens,et al.  Assessment of activities of daily living with an ambulatory monitoring system: a comparative study in patients with chronic low back pain and nonsymptomatic controls , 2002, Clinical rehabilitation.

[7]  P. Beek,et al.  Pelvis-thorax coordination in the transverse plane during gait. , 2002, Gait & posture.

[8]  J. V. van Dieën,et al.  Effects of experimentally increased trunk stiffness on thorax and pelvis rotations during walking. , 2014, Human movement science.

[9]  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.

[10]  C. Snijders,et al.  Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. , 1993, Clinical biomechanics.

[11]  Lars Arendt-Nielsen,et al.  The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study , 1996, Pain.

[12]  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.

[13]  M. Hanlon,et al.  Prediction methods to account for the effect of gait speed on lower limb angular kinematics. , 2006, Gait & posture.

[14]  D. Kerrigan,et al.  Predicting peak kinematic and kinetic parameters from gait speed. , 2003, Gait & posture.

[15]  Murray Mp,et al.  Kinematic and EMG patterns during slow, free, and fast walking , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[16]  R. Blickhan,et al.  Running on uneven ground: leg adjustments to altered ground level. , 2010, Human movement science.

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

[18]  L. Selen,et al.  Trunk muscle activation in low-back pain patients, an analysis of the literature. , 2003, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[19]  F. Keefe,et al.  An objective approach to quantifying pain behavior and gait patterns in low back pain patients , 1985, Pain.

[20]  C J Snijders,et al.  Transfer of lumbosacral load to iliac bones and legs Part 2: Loading of the sacroiliac joints when lifting in a stooped posture. , 1993, Clinical biomechanics.

[21]  K. Pfeifer,et al.  Neuromuscular control of walking with chronic low-back pain. , 2003, Manual therapy.

[22]  Idsart Kingma,et al.  Coordination of leg swing, thorax rotations, and pelvis rotations during gait: the organisation of total body angular momentum. , 2008, Gait & posture.

[23]  R. Wagenaar,et al.  Disorders in trunk rotation during walking in patients with low back pain: a dynamical systems approach. , 2001, Clinical biomechanics.

[24]  S. White,et al.  Effect of knee flexion angle on ground reaction forces, knee moments and muscle co-contraction during an impact-like deceleration landing: implications for the non-contact mechanism of ACL injury. , 2010, The Knee.