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Wenghofer J, He Beange K, Ramos WC, Mavor MP, Graham RB. Dynamic assessment of spine movement patterns using an RGB-D camera and deep learning. J Biomech 2024; 166:112012. [PMID: 38443276 DOI: 10.1016/j.jbiomech.2024.112012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
In clinical practice, functional limitations in patients with low back pain are subjectively assessed, potentially leading to misdiagnosis and prolonged pain. This paper proposes an objective deep learning (DL) markerless motion capture system that uses a red-green-blue-depth (RGB-D) camera to measure the kinematics of the spine during flexion-extension (FE) through: 1) the development and validation of a DL semantic segmentation algorithm that segments the back into four anatomical classes and 2) the development and validation of a framework that uses these segmentations to measure spine kinematics during FE. Twenty participants performed ten cycles of FE with drawn-on point markers while being recorded with an RGB-D camera. Five of these participants also performed an additional trial where they were recorded with an optical motion capture (OPT) system. The DL algorithm was trained to segment the back and pelvis into four anatomical classes: upper back, lower back, spine, and pelvis. A kinematic framework was then developed to refine these segmentations into upper spine, lower spine, and pelvis masks, which were used to measure spine kinematics after obtaining 3D global coordinates of the mask corners. The segmentation algorithm achieved high accuracy, and the root mean square error (RMSE) between ground truth and predicted lumbar kinematics was < 4°. When comparing markerless and OPT kinematics, RMSE values were < 6°. This work demonstrates the feasibility of using markerless motion capture to assess FE spine movement in clinical settings. Future work will expand the studied movement directions and test on different demographics.
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Affiliation(s)
- Jessica Wenghofer
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kristen He Beange
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada; Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, ON, Canada
| | - Wantuir C Ramos
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Matthew P Mavor
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ryan B Graham
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Ottawa-Carleton Institute for Biomedical Engineering, Ottawa, ON, Canada.
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Alsubaie AM, Sanderson A, Cabral HV, Martinez-Valdes E, Falla D. Spinal kinematic variability is increased in people with chronic low back pain during a repetitive lifting task. J Electromyogr Kinesiol 2023; 73:102832. [PMID: 37897835 DOI: 10.1016/j.jelekin.2023.102832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
Changes in spinal kinematic variability have been observed in people with chronic non-specific LBP (CNSLBP) during the performance of various repetitive functional tasks. However, the direction of these changes (i.e., less or more kinematic variability) is not consistent. This study aimed to assess differences in kinematic variability of the 3D angular displacement of thoracic and lumbar spinal segments in people with CNSLBP compared to asymptomatic individuals during a repetitive lifting task. Eleven people with CNSLBP and 11 asymptomatic volunteers performed 10 cycles of multi-planar lifting movements while spinal kinematics were recorded. For the three planes of motion, point-by-point standard deviations (SDs) were computed across all cycles of lifting and the average was calculated as a measure of kinematic variability for both segments. People with CNSLBP displayed higher thoracic (F = 8.00, p = 0.010, ηp2 = 0.286) and lumbar kinematic variability (F = 5.48, p = 0.030, ηp2 = 0.215) in the sagittal plane. Moreover, group differences were observed in the transversal plane for thoracic (F = 7.62, p = 0.012, ηp2 = 0.276) and lumbar kinematic variability (F = 5.402, p = 0.031, ηp2 = 0.213), as well as in the frontal plane for thoracic (F = 7.27, p = 0.014, ηp2 = 0.267) and lumbar kinematic variability (F = 6.11, p = 0.022, ηp2 = 0.234), all showing higher variability in those with CNSLBP. A significant main effect of group was not detected (p > 0.05) for spinal range of motion (ROM). Thus, people with CNSLBP completed the lifting task with the same ROM in all three planes of motion as observed for asymptomatic individuals, yet they performed the lifting task with higher spinal kinematic cycle-to-cycle variation.
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Affiliation(s)
- Amal M Alsubaie
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Andy Sanderson
- Department of Sport and Exercise Sciences, Manchester Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Hélio V Cabral
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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van Dijk MJH, van der Wal AM, Mollema J, Visser B, Kiers H, Heerkens Y, van der Sanden MWGN. The Observable Movement Quality scale for patients with low back pain (OMQ-LBP): validity and reliability in a primary care setting of physical therapy. BMC Musculoskelet Disord 2023; 24:705. [PMID: 37667238 PMCID: PMC10476334 DOI: 10.1186/s12891-023-06784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 08/06/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The Observable Movement Quality scale for patients with low back pain (OMQ-LBP) is a newly developed measurement instrument for use in primary care settings of physical and exercise therapists to assess movement quality (MQ) of patients with low back pain (LBP). OBJECTIVE This study aims to determine validity, reliability and feasibility of the OMQ-LBP. The OMQ-LBP consists of a standardized movement circuit (performed twice) consisting of five daily activities problematic for LBP patients, which are scored with an 11-item observation list. METHODS Construct validity was determined by testing seven hypotheses on associations between constructs (n = 85 patients with LBP) and four hypotheses on known group differences (n = 85 patients with LBP and n = 63 healthy controls; n = 35 matched participant-patients having VAS-pain ≥ 20 mm during and/or after both circuits and healthy controls). Internal consistency was analyzed with Cronbach's alpha (n = 85 patients with LBP). For inter- and intra-rater reliability Intraclass Correlation Coefficient (ICC) values were examined (n = 14 therapists: seven primary care physical therapists and seven exercise therapists). Additionally, content validity and feasibility were determined using thematic analysis of a brief interview with participants, patients (n = 38) and therapists (n = 14). RESULTS After Bonferroni correction 2/7 associations between constructs and 2/4 significant group differences were confirmed. Cronbach's alpha was 0,79. The ICC-values of interrater reliability of the OMQ-LBP total score and the duration score were 0.56 and 0.99 and intra-rater reliability 0.82 and 0,93, respectively. Thematic analysis revealed five themes. Three themes elucidate that both patients and therapists perceived the content of the OMQ-LBP as valid. The fourth theme exhibits that OMQ-LBP provides a clear and unambiguous language for MQ in patients with LBP. Theme 5 depicts that the OMQ-LBP seems feasible, but video recording is time-consuming. CONCLUSIONS The OMQ-LBP is a promising standardized observational assessment of MQ during the five most problematic daily activities in patients with LBP. It is expected that uniform and objective description and evaluation of MQ add value to clinical reasoning and facilitate uniform communication with patients and colleagues.
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Affiliation(s)
- M J H van Dijk
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands.
- Radboud University Medical CenterRadboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - A M van der Wal
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - J Mollema
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - B Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - H Kiers
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - Y Heerkens
- Department Occupation & Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Quirk DA, Johnson ME, Anderson DE, Smuck M, Sun R, Matthew R, Bailey J, Marras WS, Bell KM, Darwin J, Bowden AE. Biomechanical Phenotyping of Chronic Low Back Pain: Protocol for BACPAC. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:S48-S60. [PMID: 36315101 PMCID: PMC10403313 DOI: 10.1093/pm/pnac163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Biomechanics represents the common final output through which all biopsychosocial constructs of back pain must pass, making it a rich target for phenotyping. To exploit this feature, several sites within the NIH Back Pain Consortium (BACPAC) have developed biomechanics measurement and phenotyping tools. The overall aims of this article were to: 1) provide a narrative review of biomechanics as a phenotyping tool; 2) describe the diverse array of tools and outcome measures that exist within BACPAC; and 3) highlight how leveraging these technologies with the other data collected within BACPAC could elucidate the relationship between biomechanics and other metrics used to characterize low back pain (LBP). METHODS The narrative review highlights how biomechanical outcomes can discriminate between those with and without LBP, as well as among levels of severity of LBP. It also addresses how biomechanical outcomes track with functional improvements in LBP. Additionally, we present the clinical use case for biomechanical outcome measures that can be met via emerging technologies. RESULTS To answer the need for measuring biomechanical performance, our "Results" section describes the spectrum of technologies that have been developed and are being used within BACPAC. CONCLUSION AND FUTURE DIRECTIONS The outcome measures collected by these technologies will be an integral part of longitudinal and cross-sectional studies conducted in BACPAC. Linking these measures with other biopsychosocial data collected within BACPAC increases our potential to use biomechanics as a tool for understanding the mechanisms of LBP, phenotyping unique LBP subgroups, and matching these individuals with an appropriate treatment paradigm.
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Affiliation(s)
- D Adam Quirk
- Harvard School of Engineering and Applied Science, Harvard University, Cambridge, Massachusetts
| | - Marit E Johnson
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis E Anderson
- Center for Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Ruopeng Sun
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Robert Matthew
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, California
| | - Jeannie Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - William S Marras
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio
| | - Kevin M Bell
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessa Darwin
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anton E Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, USA
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Errabity A, Calmels P, Han WS, Bonnaire R, Pannetier R, Convert R, Molimard J. The effect of low back pain on spine kinematics: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2023; 108:106070. [PMID: 37595368 DOI: 10.1016/j.clinbiomech.2023.106070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Although impairments in dorso-lumbar spine mobility have been previously reported in patients with low back pain, its exact mechanism is not yet clear. Therefore, the purpose of this systematic review and meta-analysis is to investigate and compare spinal kinematics between subjects with and without low back pain and identify appropriate tools to evaluate it. METHODS The PubMed, Scopus and Web of Science databases were searched for relevant literature. The search strategy was mainly focused on studies investigating lumbar kinematics in subjects with and without low back pain during clinical functional tests, gait, sports and daily functional activities. Papers were selected if at least one of these outputs was reported: lumbar range of motion, lumbar velocity, lumbar acceleration and deceleration, lordosis angle or lumbar excursion. FINDINGS Among 804 papers, 48 met the review eligibility criteria and 29 were eligible to perform a meta-analysis. Lumbar range of motion was the primary outcome measured. A statistically significant limitation of the lumbar mobility was found in low back pain group in all planes, and in the frontal and transverse planes for thoracic range of motion, but there is no significant limitation for pelvic mobility. The amount of limitation was found to be more important in the lumbar sagittal plane and during challenging functional activities in comparison with simple activities. INTERPRETATION The findings of this review provide insight into the impact of low back pain on spinal kinematics during specific movements, contributing to our understanding of this relationship and suggesting potential clinical implications.
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Affiliation(s)
- Aicha Errabity
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France; Thuasne, BP243, 92307 Levallois-Perret, Cedex, France.
| | - Paul Calmels
- Université Jean Monnet, Saint-Etienne, service de médecine physique et réadaptation - CHU-Saint Etienne, Lyon1, Université Savoie Mont-Blanc, Laboratoire Inter Universitaire de biologie de la Motricité, F-42023 Saint-Etienne, France
| | - Woo-Suck Han
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Rébecca Bonnaire
- Institut Clément Ader (ICA), Université de Toulouse, CNRS, IMT Mines Albi, INSA, ISAE-SUPAERO, UPS Campus Jarlard, F-81013 Albi, France
| | | | | | - Jérome Molimard
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France
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Shih HJS, Ai J, Abe J, Tang J, Rowley KM, Van Dillen LR, Kulig K. Trunk control in and out of an episode of recurrent low back pain in young adults during the Balance-Dexterity Task. J Electromyogr Kinesiol 2023; 71:102794. [PMID: 37348263 DOI: 10.1016/j.jelekin.2023.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
We investigated motor control strategies utilized by individuals with recurrent low back pain (rLBP) during active pain and remission periods as well as by back-healthy controls using the Balance-Dexterity Task. Nineteen young adults with rLBP were tested first when they were in pain and then again in symptom remission, and 19 matched controls were also tested. Trunk kinematic coupling and muscle co-activation were examined while participants performed the task by standing on one leg while compressing a spring with a maximum consistent force with the other leg. We found a decreased bilateral external oblique co-activation during the spring condition of the task compared to the stable block condition in people with rLBP compared to back healthy individuals. There was also reduced trunk coupling during the spring condition of the task compared to the stable block condition in both the rLBP active and remission groups, but no group difference between rLBP and back-healthy individuals. When individuals were in active pain, they exhibited more co-activation than when they were in remission, but the co-activation during active pain was not greater than in back-healthy individuals.
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Affiliation(s)
- Hai-Jung Steffi Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States.
| | - Joyce Ai
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Justin Abe
- Department of Biological Sciences, University of Southern California, Los Angeles, CA, United States
| | - Jiaxi Tang
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - K Michael Rowley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States; Kinesiology Department, California State University East Bay, Hayward, CA, United States
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University in St. Louis Medical School, St. Louis, MO, United States; Department of Orthopaedic Surgery, Washington University in St. Louis Medical School, St. Louis, MO, United States
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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Wattananon P, Kongoun S, Chohan A, Richards J. The use of statistical parametric mapping to determine altered movement patterns in people with chronic low back pain. J Biomech 2023; 153:111601. [PMID: 37126886 DOI: 10.1016/j.jbiomech.2023.111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
Kinematics studies have generally focused on the quantity of movement using discrete parameters such as maximum and minimum angles to compare between people with chronic low back pain (CLBP) and healthy individuals. However, discrete parameters cannot be used to fully describe movement patterns and segmental contributions. This study aimed to explore the use of Statistical Parametric Mapping (SPM) to characterize quality of movement by examining if differences in movement patterns exist between groups, and within-group segmental contributions, during active movement tests. Twenty-one individuals with CLBP and nine healthy individuals were recruited. Inertial Measurement Unit (IMUs) were attached at thoracic (T3) and lumbar (L1) spine, and pelvis (S1) to collect active trunk flexion, extension, rotation, and lateral bend. SPM was used to analyze between-group movement patterns and within-group segmental contributions. SPM revealed no significant differences (P > 0.05) between groups. However, a greater lumbar contribution (P < 0.001) was observed during 10-40% of flexion followed by a greater pelvic contribution (P < 0.001) during 60-90% of flexion, while a greater lumbar than thoracic contribution (P < 0.001) was observed during flexion and the return to upright position in individuals with CLBP. Individuals with CLBP used a greater thoracic contribution compared to lumbar contribution (P < 0.001) during rotation, while a greater lumbar contribution compared to pelvic contribution was observed (P < 0.001) during lateral bending. Our findings suggest that SPM approach was able to detect differences in thoracic, lumbar, and pelvic velocity contributions and timings between segments in individuals with CLBP. These findings may help improving inter-rater reliability of clinical observations.
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Affiliation(s)
- Peemongkon Wattananon
- Spine Biomechanics Laboratory, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
| | - Sasithorn Kongoun
- Spine Biomechanics Laboratory, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
| | - Ambreen Chohan
- Allied Health Research Unit, University of Central Lancashire, Preston, Lancashire PR1 2HE, United Kingdom.
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, Lancashire PR1 2HE, United Kingdom.
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Fayad J, Eltes PE, Lazary A, Cristofolini L, Stagni R. Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review. BMC Musculoskelet Disord 2022; 23:1080. [PMID: 36503435 PMCID: PMC9743750 DOI: 10.1186/s12891-022-05925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Spine disorders are becoming more prevalent in today's ageing society. Motion abnormalities have been linked to the prevalence and recurrence of these disorders. Various protocols exist to measure thoracolumbar spine motion, but a standard multi-segmental approach is still missing. This study aims to systematically evaluate the literature on stereophotogrammetric motion analysis approaches to quantify thoracolumbar spine kinematics in terms of measurement reliability, suitability of protocols for clinical application and clinical significance of the resulting functional assessment. METHODS Electronic databases (PubMed, Scopus and ScienceDirect) were searched until February 2022. Studies published in English, investigating the intersegmental kinematics of the thoracolumbar spine using stereophotogrammetric motion analysis were identified. All information relating to measurement reliability; measurement suitability and clinical significance was extracted from the studies identified. RESULTS Seventy-four studies met the inclusion criteria. 33% of the studies reported on the repeatability of their measurement. In terms of suitability, only 35% of protocols were deemed suitable for clinical application. The spinous processes of C7, T3, T6, T12, L1, L3 and L5 were the most widely used landmarks. The spine segment definitions were, however, found to be inconsistent among studies. Activities of daily living were the main tasks performed. Comparable results between protocols are however still missing. CONCLUSION The literature to date offers various stereophotogrammetric protocols to quantify the multi-segmental motion of the thoracolumbar spine, without a standard guideline being followed. From a clinical point of view, the approaches are still limited. Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance.
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Affiliation(s)
- Jennifer Fayad
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy ,National Centre for Spinal Disorders, Budapest, Hungary
| | - Peter Endre Eltes
- National Centre for Spinal Disorders, Budapest, Hungary ,In Silico Biomechanics Laboratory, National Centre for Spinal Disorders, Budapest, Hungary
| | - Aron Lazary
- National Centre for Spinal Disorders, Budapest, Hungary
| | - Luca Cristofolini
- grid.6292.f0000 0004 1757 1758Department of Industrial Engineering, Alma Mater Studiorum – Università di Bologna, Bologna, Italy
| | - Rita Stagni
- grid.6292.f0000 0004 1757 1758Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, Alma Mater Studiorum – Università Di Bologna, Bologna, Italy
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Miñambres-Martín D, Martín-Casas P, López-de-Uralde-Villanueva I, Fernández-de-las-Peñas C, Valera-Calero JA, Plaza-Manzano G. Physical Function in Amateur Athletes with Lumbar Disc Herniation and Chronic Low Back Pain: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063743. [PMID: 35329430 PMCID: PMC8953459 DOI: 10.3390/ijerph19063743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to analyze if chronic low back pain (LBP) and lumbar disc herniation induce biomechanics, flexibility, body balance, physical activity, and muscular function alterations compared to a similar asymptomatic cohort. Fifty male volunteers (n = 25 with chronic LBP and lumbar disc herniation and n = 25 pain-free subjects) were enrolled. Range of motion (internal and external hip rotation, ankle dorsiflexion, and active straight leg raise, ASLR), trunk flexibility (finger−floor distance), body balance (Y-balance test) and muscle function (Biering−Sorensen test, prone and lateral bridges) outcomes were assessed. Comparative analyses between sides and group were conducted. Results: Patients showed greater weight and BMI compared with controls (p < 0.05). None of the outcomes bilaterally assessed showed side-to-side differences for pain-free participants (all, p > 0.05) or LBP patients (all, p > 0.05). Regarding the differences between groups, LBP patients showed limited internal hip rotation (p < 0.001), finger−floor distance (p < 0.001), body balance (p < 0.001), and muscle endurance (planks p < 0.001; Biering−Sorensen test p < 0.05). External hip rotation, ASLR, and ankle dorsiflexion range of movement were comparable in both groups (p > 0.05). The sample of pain-free amateur athletes showed greater range of movement for internal hip rotation, lower finger−floor distance, better body balance, and muscle function. However, the external hip rotation, ankle dorsiflexion, and ASLR tests showed no difference between cases and controls.
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Affiliation(s)
- Diego Miñambres-Martín
- Premium Madrid Global Health Care, 28016 Madrid, Spain;
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-C.); (I.L.-d.-U.-V.); (G.P.-M.)
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-C.); (I.L.-d.-U.-V.); (G.P.-M.)
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain
- Correspondence:
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-C.); (I.L.-d.-U.-V.); (G.P.-M.)
- Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
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Shih HJS, Van Dillen LR, Kutch JJ, Kulig K. Individuals with recurrent low back pain exhibit further altered frontal plane trunk control in remission than when in pain. Clin Biomech (Bristol, Avon) 2021; 87:105391. [PMID: 34118490 PMCID: PMC8392132 DOI: 10.1016/j.clinbiomech.2021.105391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Movement alterations due to low back pain (LBP) could lead to long-term adverse consequences if they do not resolve after symptoms subside. This study aims to determine if altered trunk control associated with recurrent low back pain persists beyond symptom duration. METHODS Twenty young adults with recurrent LBP were tested once during an LBP episode and once in symptom remission, and twenty matched back-healthy participants served as controls. Participants walked on a treadmill with five prescribed step widths (0.33, 0.67, 1, 1.33, 1.67 × preferred step width). Motion capture and surface electromyography were used to record trunk kinematics and muscle activation. Thorax-pelvis coordination was calculated using vector coding, and longissimus activation and co-activation were analyzed. FINDINGS Young adults with recurrent LBP exhibited a "looser" trunk control strategy in the frontal plane during gait that was persistent regardless of pain status across multiple step widths compared to controls. The looser trunk control was demonstrated by a greater pelvis-only, less thorax-only coordination pattern, and decreased bilateral longissimus co-activation in individuals with recurrent LBP compared to controls. The looser trunk control strategy was further amplified when individuals were in symptom remission and exhibited greater trunk excursion and reduced in-phase coordination in the frontal plane. INTERPRETATION The amplification of aberrant movement during symptom remission may suggest that movement patterns or anatomical factors existing prior to the tested painful episode underlie altered trunk control in individuals with recurrent LBP. The symptom remission period of recurrent LBP may be a critical window into clinical evaluation and treatment.
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Affiliation(s)
- Hai-Jung Steffi Shih
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Consistent differences in lumbar spine alignment between low back pain subgroups and genders during clinical and functional activity sitting tests. Musculoskelet Sci Pract 2021; 52:102336. [PMID: 33548765 PMCID: PMC8918047 DOI: 10.1016/j.msksp.2021.102336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subgroups of people with low back pain display differences in their lumbar alignment during tests from a clinical examination. However, it is unknown if subgroups display the same patterns during a functional activity test and if gender influences subgroup-related differences. OBJECTIVES Test if differences in lumbar alignment between two LBP subgroups are 1) present during a functional activity test of preferred sitting and 2) independent of gender. DESIGN Cross-sectional. METHOD 154 participants with chronic low back pain were classified based on the Movement System Impairment Classification System by a physical therapist. Participants performed a functional activity test of preferred sitting and clinical tests of maximum flexed and extended sitting. 3D marker co-ordinate data were collected. Sagittal plane lumbar alignment, indexed by lumbar curvature angle, was calculated. A three-way mixed effect analysis of variance was used to examine effects of test, subgroup, gender, subgroup × test, gender × test and subgroup × gender. RESULTS/FINDINGS The lumbar rotation with extension subgroup [LCA = -8.0° (-9.5,-6.5)] displayed a more extended lumbar alignment than lumbar rotation [LCA = -5.9° (-7.4,-4.4)]. Women [LCA = -10.7° (-12.3,-9.2)] displayed a more extended lumbar alignment than men [LCA = -3.2° (-4.7,-1.7)]. There was a significant gender × test interaction (p = 0.01). The subgroup × test (p = 0.99) and subgroup × gender (p = 0.76) interactions were not significant. CONCLUSIONS LBP subgroup differences in lumbar alignment are present during preferred sitting. Gender-related differences in lumbar alignment are not driving subgroup differences. These findings highlight the need to use patient-specific clinical characteristics to guide treatment of a functional activity of preferred sitting limited due to low back pain.
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Cholewicki J, Breen A, Popovich JM, Reeves NP, Sahrmann SA, van Dillen LR, Vleeming A, Hodges PW. Can Biomechanics Research Lead to More Effective Treatment of Low Back Pain? A Point-Counterpoint Debate. J Orthop Sports Phys Ther 2019; 49:425-436. [PMID: 31092123 PMCID: PMC7394249 DOI: 10.2519/jospt.2019.8825] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Although biomechanics plays a role in the development and perhaps the persistent or recurrent nature of low back pain (LBP), whether biomechanics alone can provide the basis for intervention is debated. Biomechanics, which refers to the mechanics of the body, including its neuromuscular control, has been studied extensively in LBP. But, can gains be made in understanding LBP by research focused on this component of biology in the multifactorial biopsychosocial problem of LBP? This commentary considers whether biomechanics research has the potential to advance treatment of LBP, and how likely it is that this research will lead to better treatment strategies. A point-counterpoint format is taken to present both sides of the argument. First, the challenges faced by an approach that considers biomechanics in isolation are presented. Next, we describe 3 models that place substantial emphasis on biomechanical factors. Finally, reactions to each point are presented as a foundation for further research and clinical practice to progress understanding of the place for biomechanics in guiding treatment of LBP. J Orthop Sports Phys Ther 2019;49(6):425-436. Epub 15 May 2019. doi:10.2519/jospt.2019.8825.
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