Gait in Pregnancy-related Pelvic girdle Pain: amplitudes, timing, and coordination of horizontal trunk rotations

The effect of lumbopelvic region rotation relative flexibility on thorax-pelvis and pelvis-femur coordination during walking

BACKGROUND

Lumbopelvic region rotation relative flexibility (LRRF), which is defined as lumbopelvic region that is relatively less stiffness than the hip region, is associated with low back pain (LBP) symptoms. However, how LRRF is influenced by lumbopelvic region motion during walking is unclear.

RESEARCH QUESTION

What is the influence of LBP and LRRF on coordination patterns of the thorax, pelvis, and femur during walking?

METHODS

The presence of LRRF was determined based on whether the lumbopelvic rotation occurred in the first 50% of knee flexion or hip external rotation movement. Participants with LBP and LRRF were classified into the LBP group. Participants with LRRF but without LBP were classified into the early pelvis rotation (ROT) group, and those without LBP and relative flexibility were classified as controls. The thorax-pelvis coordination and pelvis-femur coordination during the stance cycles were calculated from the segmental angles obtained by three-dimensional motion analysis using a modified vector coding technique.

RESULTS

In the sagittal plane, the thorax-pelvis coordination of the LBP group showed more anti-phase patterns at both the early stance and midstance compared with controls and the ROT group. In the sagittal and horizontal planes, pelvis-femur coordination of the LBP and ROT groups showed more in-phase patterns during the early stance and midstance compared with controls.

SIGNIFICANCE

Regardless of LBP, the presence of LRRF alters the intersegmental coordination during walking. In individuals with LRRF, stiffness of the hip may increase during walking. People who have LRRF without LBP may develop LBP in the future, and it is important for prevention to identify these differences in kinematics during walking.

Motor control of the spine in pregnancy-related lumbopelvic pain: A systematic review

BACKGROUND

Some studies observed differences in motor control of the spine between women with pregnancy-related lumbopelvic pain and matched controls. Understanding alterations in spine motor control may help optimizing treatment in this population. The objective is to determine if there are differences in motor control of the spine in pregnant and post-partum women with and without pregnancy-related lumbopelvic pain.

METHODS

Five databases were searched: MEDLINE, Embase, CINAHL, Web of Science and Evidence-Based Medicine Reviews (last search: February 4th 2021). Observational studies that compared motor control of the lumbopelvic spine (in terms of muscle activation [e.g. using EMG or ultrasound imaging] or kinematics) between women with pregnancy-related lumbopelvic pain and matched controls were included. Risk of bias was assessed with a modified version of STROBE statement for cross-sectional studies. No meta-analysis was performed.

FINDING

Fifteen studies were included. Compared to matched controls, pregnant women with pregnancy-related lumbopelvic pain showed differences in lumbar spine kinematic during walking and lifting, although not consistent between studies. The only consistent results were higher transversus abdominis muscle activation during leg movements in post-partum pregnancy-related lumbopelvic pain. Differences in pelvic floor muscle function was inconsistent.

INTERPRETATION

This systematic review identified multiple differences in motor control in pregnancy-related lumbopelvic pain population, predominantly in dynamic tasks. However, consistent differences in lumbopelvic spine motor control were rare. More studies are necessary to determine if motor control is different in pregnancy-related lumbopelvic pain to better understand alteration in motor control and to optimize the efficacy of rehabilitation treatments.

An exploratory analysis of gait biomechanics and muscle activation in pregnant females with high and low scores for low back or pelvic girdle pain during and after pregnancy

BACKGROUND

The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy.

METHODS

Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS <15) based on third trimester scores. Two-way mixed model ANOVAs were used to compare high and low pain groups over time.

FINDINGS

Nine participants met the high pain group criteria and 11 were low pain. During second trimester the high pain group compared to the low pain group demonstrated smaller peak hip flexor moments, total hip work, percent hip contribution to work, and larger percent ankle contribution to work. Pregnant females demonstrated greater hip, knee, and ankle moments, ankle work, and gluteus maximus muscle activation third trimester than second trimester.

INTERPRETATION

Reduced hip and greater ankle contribution to work in the high pain group during second trimester could indicate decreased hip utilization early in pregnancy and may contribute to disability as pregnancy progresses. It is also possible kinetic differences during second trimester reflect an early strategy to reduce pain by avoiding hip joint loading. Increased moments and work during third trimester indicate a clinical imperative to better prepare pregnant females to accommodate increased joint loading and muscular demand.

Visceral Therapy and Physical Activity for Selected Dysfunctions, with Particular Emphasis on Locomotive Organ Pain in Pregnant Women-Importance of Reducing Oxidative Stress

Movement is a physiological phenomenon and a fundamental aspect of the living human body in a global context (e.g., musculoskeletal system function) and local one (e.g., visceral system function). The local activity of the body is expressed in the rhythm of pulsations, peristalsis and vibrations. Visceral therapy supports movement, articulation and tissue rhythm. The use of visceral treatment for pain is complementary and is relevant for pregnant women. Maintaining the mobility and motility of internal organs by means of visceral techniques can regulate anatomical relations and physiological processes within the urogenital diaphragm. The role of physical activity is also important. A scoping review was conducted to analyze the relevant literature on pain in pregnant women, the role of visceral therapy in pregnant women and oxidative stress. Eligible articles presented aspects of the occurrence of pain in locomotive organs in pregnant women, the use of visceral therapy in pain management, and the reduction of oxidative stress. The use of visceral therapy and physical activity in the treatment of pain is complementary and also important for pregnant women, and so may have an effect on reducing oxidative stress in pregnant women.

Coordination of Axial Trunk Rotations During Gait in Low Back Pain. A Narrative Review

Chronic low back pain patients have been observed to show a reduced shift of thorax-pelvis relative phase towards out-of-phase movement with increasing speed compared to healthy controls. Here, we review the literature on this phase shift in patients with low back pain and we analyze the results presented in literature in view of the theoretical motivations to assess this phenomenon. Initially, based on the dynamical systems approach to movement coordination, the shift in thorax-pelvis relative phase with speed was studied as a self-organizing transition. However, the phase shift is gradual, which does not match a self-organizing transition. Subsequent emphasis in the literature therefore shifted to a motivation based on biomechanics. The change in relative phase with low back pain was specifically linked to expected changes in trunk stiffness due to 'guarded behavior'. We found that thorax-pelvis relative phase is affected by several interacting factors, including active drive of thorax rotation through trunk muscle activity, stride frequency and the magnitude of pelvis rotations. Large pelvis rotations and high stride frequency observed in low back pain patients may contribute to the difference between patients and controls. This makes thorax-pelvis relative phase a poor proxy of trunk stiffness. In conclusion, thorax-pelvis relative phase cannot be considered as a collective variable reflecting the orderly behaviour of a complex underlying system, nor is it a marker of specific changes in trunk biomechanics. The fact that it is affected by multiple factors may explain the considerable between-subject variance of this measure in low back pain patients and healthy controls alike.

Trunk, pelvic and hip kinematics during the Stork test in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women

BACKGROUND

Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test.

METHODS

In this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance.

FINDINGS

Few and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals) -1.1° (-2.4°, 0.3°) and 1.0° (-0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1° (1.6°, 6.7°) and 7.9° (5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4° (77.0°, 83.9°) and 74.1° (70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups.

INTERPRETATION

Our findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.

Influence of kinesiophobia with pregnancy-related lumbopelvic pain at late pregnancy on postpartum depressive symptoms

OBJECTIVE

To investigate whether kinesiophobia with pregnancy-related lumbopelvic pain at late pregnancy influenced depressive symptoms at 1 month after delivery.

METHOD

Final participants were 43 pregnant women who experienced pregnancy-related lumbopelvic pain at late pregnancy and completed self-reported questionnaires at late pregnancy and 1 month after delivery. The Tampa Scale for Kinesiophobia was used to evaluate kinesiophobia, and depressive symptoms were assessed using the Self-Rating Depression Scale. We divided participants into two groups (depression and no-depression) using the score of the Self-Rating Depression Scale at 1 month after delivery. Univariate analysis and multiple logistic regression analysis identified kinesiophobia at late pregnancy as an independent predictor of depression at 1 month after delivery.

RESULTS

In univariate analysis, kinesiophobia at late pregnancy was significantly higher in the depression group than in the no-depression group (P= .033). In multiple logistic regression analysis, kinesiophobia at late pregnancy were significantly associated with depression at 1 month after delivery even after adjusting for confounding factors (Odds Ratio, 1.25; 95% Confidence Interval, 1.03-1.52).

CONCLUSION

Results found that kinesiophobia at late pregnancy negatively influenced depressive symptoms at 1 month after delivery, suggesting that approaches to treat kinesiophobia at late pregnancymight reduce the risk of onset of postpartum depressive symptoms.

Pelvic movements during walking throughout gestation - the relationship between morphology and kinematic parameters

BACKGROUND

Many researchers emphasize adaptations following pregnancy. Our purpose was to get more insight into how morphology interacts with the pelvic walking pattern - the segment most prone to the adaptation following altered body demands.

METHODS

Thirty women were enrolled. Three experimental sessions were arranged according to the same protocol in the first, second and third trimesters of pregnancy. First, the anthropometric measures were taken, then walking trials at a self-selected speed were registered. At the end of the experimental session the subjects were asked to fill out a questionnaire on pain.

FINDINGS

The sagittal plane pelvic range of motion (RoM) significantly increased throughout pregnancy. There were significant positive correlations between pelvic anthropometric dimensions and pelvic tilt and rotation primarily in the third trimester of pregnancy. Significant positive correlations were found between pelvic RoM and thigh circumference. Indicators associated with body mass increase were positively correlated with pelvic obliquity in the second trimester and pelvic tilt and rotation in late pregnancy. It is also worth noting that the individual differences were not related to back pain and that the reported correlations were observed in some but not in all trimesters.

INTERPRETATION

Morphological changes following the fetus growth induced increased pelvic tilt and rotation, however, pelvis movements were not associated with back pain. Overall, the results highlight correlations between morphology and pelvis kinematic patterns in some but not in all trimesters.

UPPER BODY AXIAL ROTATIONS IN DIFFERENT AGE-GROUPS DURING LEVEL WALKING

High amplitude of movements in the lower body during walking is attenuated in the upper body to stabilize the head, which serves as the platform of critical sensory systems (vestibular and visual). The upper body attenuation has been investigated on the linear acceleration, however, not on the angular motion. This study aimed to compare the attenuation of axial rotation in different age-groups. Methods: Thirty healthy men (15 young and 15 elderly) participated in this study. Subjects walked on a level surface with gyro sensors attached at four locations of the back (pelvis, thorax, shoulder, and head), from which the angular motion was derived. Outcome measures included the average peak-to-peak amplitude of axial rotation at all sensor locations and the phase delay at each location with reference to the pelvis. Results: Age-position interaction was significant for both the amplitude and phase delay. Post hoc test revealed that rotation amplitude was similar at pelvis, thorax and shoulder in the elderly, whereas it was significantly reduced at the thorax-shoulder section in the young. The elderly also showed smaller phase delay at shoulder and head than those of the young. Discussion: The results suggest that the attenuation by upper trunk was reduced and the shoulder and head motions were more tightly coupled to the pelvis in the elderly, i.e., the upper body moved more like a rigid body in the axial motion.

The Biomechanics of Pregnancy: A Systematic Review

During pregnancy, a number of biomechanical and hormonal changes occur that can alter spinal curvature, balance, and gait patterns by affecting key areas of the human body. This can greatly impact quality of life (QOL) by increasing back pain and the risk of falls. These effects are likely to be the ultimate result of a number of hormonal and biomechanical changes that occur during pregnancy. Research Question and Methodology: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, this systematic review sets out to analyse all available literature relating to the biomechanics factors caused by pregnancy and assess how this might reduce QOL. Fifty papers were deemed eligible for inclusion in this review based on the PUBMED and SCOPUS databases. Results: Angles of lordosis and kyphosis of the spine are significantly increased by pregnancy, but not consistently across all studies. Back pain is significantly increased in pregnant women, although this is not significantly correlated with spinal changes. Increased movements of centre of pressure (COP) and increased stability indexes indicate postural control is reduced in pregnancy. Trunk range of motion, hip flexion, and extension are reduced, as well as decreased stride length, decreased gait velocity, and increased step width; again, not consistently. It is likely that each woman adopts unique techniques to minimise the effects, for example increasing step width to improve balance. Further research should focus on how altered limb kinematics during gait might affect QOL by influencing the human body, as well as assessing parameters in all planes to develop a wider understanding of pregnant biomechanical alterations.

Anticipatory postural control differs between low back pain and pelvic girdle pain patients in the absence of visual feedback

PURPOSE

The aim of this study was to examine the effect of vision on anticipatory postural control (APA) responses in two groups of clinically diagnosed chronic low back pain patients, those with Posterior Pelvic Girdle pain and those with Non-Specific Low Back Pain compared to a matched group of healthy controls during the modified Trendelenburg task.

METHODS

Seventy-eight volunteer participants (60 females and 18 males) gave informed consent to take part in this study. 39 with confirmed LBP or PGP lasting longer than 12 weeks and 39 healthy matched controls performed 40 single leg lift tasks (hip flexion to 90° as quickly as possible) with their non-dominant lower limb. A force plate was used to determine the medial-lateral displacement of the center of pressure, and the initiation of weight shift; kinematics was used to determine initiation of leg lift; and electromyography was used to determine onset times from the external oblique (EO), internal oblique (IO) and lumbar multifidus (MF), gluteus maximus (GM) and biceps femoris (BF).

RESULTS

The PGP group showed significantly longer muscle onset latencies in the BF, EO MF with visual occlusion (F_2,746 = 4.51, p < .0001).

CONCLUSION

The muscle onset delays identified between the two LBP sub-groups suggests that pain may not be the primary factor in alteration of APA response. The PGP group show a greater reliance on vision which may signal impairment in multiple feedback channels.

The Timed Up & Go test in pregnant women with pelvic girdle pain compared to asymptomatic pregnant and non-pregnant women

BACKGROUND

The Timed Up and Go (TUG) test, a standardized functional mobility test, has been proposed as a physical performance-based measure in pregnant women with pelvic girdle pain (PGP).

OBJECTIVES

This cross-sectional study aimed to investigate physical function by the use of TUG in pregnant women with PGP compared to asymptomatic pregnant and non-pregnant women, and to identify factors associated with increased TUG.

METHODS

In total, 25 pregnant women with PGP, 24 asymptomatic pregnant and 25 asymptomatic non-pregnant women participated. One-way analysis of variance was used to explore difference in TUG between the groups and multiple linear regression analyses to explore associations between TUG and potential explanatory variables.

RESULTS

The time on TUG varied among pregnant women with PGP, and was significantly higher (mean (95% CI) 6.9 (6.5, 7.3) seconds) than for asymptomatic pregnant (5.8 (5.5, 6.0), p < 0.001) and non-pregnant (5.5 (5.4, 5.6), p < 0.001) women. In the total study sample, group, increased BMI and sick leave were significantly associated with increased TUG (p-values≤0.02). In pregnant women with PGP, pain intensity was the only significant clinical factor associated with increased TUG (p = 0.002).

CONCLUSION

Pregnant women with PGP used longer time and showed larger variation in TUG than asymptomatic pregnant and non-pregnant women, this underpins that TUG targets activities relevant to PGP. Our results provide new knowledge about factors influencing TUG time. Importantly, multivariable analyses suggest that pain intensity should be considered when interpreting TUG time in pregnant women with PGP.

Axial pelvis range of motion affects thorax-pelvis timing during gait

During gait, patients with pelvic girdle pain and low back pain demonstrate an altered phase relationship between axial thorax and pelvis rotations (thorax-pelvis relative phase). This could be the result of an increase in axial pelvis range of motion (ROM) which has been observed in these patients as well. To establish this relationship, we investigated if altered axial pelvis ROM during gait affects thorax-pelvis relative phase in 12 healthy subjects. These subjects walked on a treadmill and received real-time feedback on axial pelvis rotations. Subjects were asked to (1) walk normal, and walk with (2) decreased and (3) increased pelvis ROM. Gait speed and stride frequency were matched between trials. Subjects were able to increase pelvis ROM to a large extent, but the reduction in pelvis ROM was relatively small. Walking with large pelvis ROM resulted in a change in thorax-pelvis relative phase similar to that in pelvic girdle pain and low back pain. A forward dynamic model was used to predict the effect of manipulation of pelvis ROM on timing of thorax rotations independent of apparent axial trunk stiffness and arm swing amplitude (which can both affect thorax-pelvis relative phase). The model predicted a similar, even larger, effect of large axial pelvis ROM on thorax-pelvis relative phase, as observed experimentally. We conclude that walking with actively increased ROM of axial pelvis rotations in healthy subjects is associated with a shift in thorax-pelvis relative phase, similar to observations in patients with pelvic girdle pain and low back pain.

Kinematic and spatiotemporal gait characteristics in pregnant women with pelvic girdle pain, asymptomatic pregnant and non-pregnant women

BACKGROUND

Walking difficulties are common among pregnant women with pelvic girdle pain. This cross-sectional study investigated the influence of pelvic girdle pain, pregnancy and speed on spatiotemporal and trunk, pelvic and hip kinematics during gait in the 2nd trimester of pregnancy.

METHODS

Three-dimensional gait analysis at self-selected speed was performed in 25 pregnant women with pelvic girdle pain, 24 asymptomatic pregnant and 24 non-pregnant women. Linear mixed models were used to investigate between-group differences in gait variables. Adjustment for gait speed was included in the analysis. Correlations between speed and fear of movement, disability and pain were examined using Spearman correlation coefficient (r_s).

FINDINGS

Pregnant women with pelvic girdle pain walked 18% slower (estimated marginal means (95% confidence intervals) 1.18 (1.22, 1.24) meter/s) compared to asymptomatic pregnant women (1.44 (1.38, 1.50) meter/s) (P < 0.001). Moreover, with longer double limb support (5%, P = 0.04), shorter contralateral step length (3%, P = 0.03) and more restricted pelvic and hip kinematics (0.001 ≤ P ≤ 0.01) adjusted for speed. Only stance, double limb support and thoracic rotation (0.001 ≤ P ≤ 0.04) differed between asymptomatic pregnant and non-pregnant women. Speed was negatively correlated with fear of movement (r_s = -0.63, P = 0.01) and disability (r_s = -0.46, P = 0.03) in the pelvic girdle pain group.

INTERPRETATION

Gait is primarily influenced by pelvic girdle pain and less by pregnancy. Pregnant women with pelvic girdle pain walked slower and with a more rigid gait pattern compared to asymptomatic pregnant women, presumably related to altered load transfer. Our results may assist clinical evaluation of pelvic girdle pain, as well as direct future research.

Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis

Background

Comparative studies of total hip arthroplasty using the direct anterior approach (DAA) compared with the anterolateral approach (ALA) by gait analysis compared the results of the two groups, the damage to the abductor muscle, with objective and detailed kinematic as well as kinetic data of actual gait. The purpose of this systematic review was to analyze the differences in gait such as time-dependent parameters, kinetics, and kinematics after THA using the DAA compared with ALA.

Methods

PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE and AHRQ carried out a comprehensive search for all relevant randomized controlled trials and comparative studies, up to December 2018. Based on the following criteria, studies were selected: 1) study design: randomized controlled trials or non-randomized comparative studies; 2) study population: patients with primary osteoarthritis or avascular necrosis; 3) intervention: total hip arthroplasty by DAA or ALA; 4) Kinetic and kinematic data after gait analysis in the plains during postoperative follow-up.

Results

Of the 148 studies, 7 randomized controlled trials and 5 comparative studies were finally included in this systematic review. The peak hip flexion within 3 months after surgery was described in two studies and was significantly higher in the DAA group. (OR = 1.90; 95% CI [1.67,2.13]; P < 0.01, Z = 16.18). The gait speed within 3 months after surgery was reported in 3 studies and was significantly higher in the DAA group than in the ALA group. (SMD = 0.17; 95% CI [0.12,0.22]; P < 0.01, Z = 6.62) There was no difference between the two groups in stride length, step length, and hip range of motion in sagittal plane.

Conclusions

In this meta-analysis, gait speed and peak hip flexion within 3 months after surgery were significantly higher in the DAA group than in the ALA group. Despite a few significant differences between two approaches, determining whether the reported differences in terms of postoperative gait values are clinically meaningful remains a substantial challenge.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2450-2) contains supplementary material, which is available to authorized users.

Axial Thorax-Pelvis Coordination During Gait is not Predictive of Apparent Trunk Stiffness

The coordination of axial thorax and pelvis rotations during gait has been shown to be affected by several pathologies. This has been interpreted as an indication of increased apparent axial trunk stiffness, but arm swing may also affect these rotations. The objectives of this study were to assess the effect of trunk stiffness and arm swing on the relative timing (‘coordination’) between thorax and pelvis rotations, and to assess if apparent trunk stiffness can be inferred from thorax-pelvis kinematics. A forward dynamic model was constructed to estimate apparent trunk stiffness from observed thorax and pelvis rotations and arm swing moment around the longitudinal axis of the trunk of 30 subjects. The effect of independent manipulations of trunk stiffness and arm swing moment on thorax-pelvis coordination and gain of axial thorax-pelvis rotations were assessed using the same forward dynamic model. A linear regression model was constructed to evaluate whether forward dynamic model-based estimates of axial trunk stiffness could be inferred directly from thorax-pelvis rotations. The forward dynamic model revealed that axial trunk stiffness and arm swing moment have opposite effects on axial thorax-pelvis coordination. Apparent axial trunk stiffness could not be predicted from observed thorax-pelvis rotations.

Spatiotemporal gait changes in healthy pregnant women and women with pelvic girdle pain: A systematic review

INTRODUCTION

Gait is affected in women with pelvic girdle pain (PGP), a musculoskeletal condition affecting 20% of pregnant women. Whilst there is evidence of spatiotemporal changes in gait during healthy pregnancy, less is known in relation to women with PGP. Appreciating gait characteristics during healthy pregnancy could inform our understanding of the role of gait in PGP.

PURPOSE

The purpose of this review was to systematically analyse differences in the spatiotemporal parameters of gait in healthy pregnant women and those with PGP, and to make recommendations to improve research methods in investigating gait in PGP women.

METHODS

The review was undertaken following the PRISMA guidelines. Three databases and pre-existing literature were electronically and manually searched. Study selection and data extraction were conducted by two reviewers. Quality assessment was performed using the NHLBI tool for Observational Cohort and Cross-sectional Studies.

RESULTS

The search returned 2925 results. Fourteen studies were selected for data extraction. Twelve studies investigated gait in healthy pregnant women and two in PGP women. Studies employed either a cohort or cross-sectional design and used various methods to assess gait. Three, nine and two studies were high, medium and low in quality, respectively. Direct comparisons between studies were impeded due to incomparable gestational time-points investigated, in addition to variations in gait parameters and definitions used.

CONCLUSION

Evidence from studies on healthy pregnant women could inform future research on PGP women, for which current evidence is scarce. We recommend the standardisation of critical factors to allow inter-study comparisons for a meta-analysis.

Pelvic belts and pregnancy-related pelvic girdle pain: influence on temporal and spatial gait parameters

The aims of this study were to analyze temporal and spatial parameters of gait during pregnancy in women with and without PGP, to evaluate the effect of pelvic belts on temporal and spatial gait parameters, and to compare two types of belts. A total of 46 pregnant women with PGP, 58 healthy pregnant women and 23 non-pregnant women were recruited. Temporal and spatial parameters were analysed by an walkway. Two pelvic belts for pregnant women were used. An analysis of variance for repeated measures were used. In pregnant women with PGP, compared to healthy pregnant women, gait cycle and stance phase times were lower and single support time was higher. Compared to the non-pregnant women, gait velocity and step length were lower. Stance phase and double support times were higher. During pregnancy, wearing a pelvic belt modified gait velocity, single support phase, step length, step width, stance phase and toe in/out in pregnant women with PGP. Gait adaptations in pregnant women with PGP showed nearly the same changes found in women without PGP. The belts had an effect on gait in pregnant women with PGP, probably through a biomechanical and proprioceptive mechanism.

Gait analysis of pregnant patients with lumbopelvic pain using inertial sensor

BACKGROUND

Lumbopelvic pain (LPP) is one of the most common discomforts during pregnancy. However, few studies have evaluated relation between LPP and gait in pregnancy quantitatively.

RESEARCH QUESTION

This study aimed to investigate the relation between the LPP and gait characteristics such as symmetry, stability, and the degree of motion during pregnancy.

METHODS

Gait data were collected for fifty-two pregnant women between the third and tenth month of pregnancy on smooth, horizontal walkway by using inertial measurement sensor units attached to the participants' lumbar. The degrees of trunk movement, movement symmetry, gait variability, and symmetry of rotation were expressed as the root mean square (RMS), autocorrelation peak (AC), coefficient of variance (CV), and the degree of asymmetry at the approximate amount of angular variation (DA) respectively, which were calculated from measured acceleration data and angular velocity data. An independent t-test was performed to investigate differences in these gait parameters between LPP group and pain free group classified according to the presence or absence of the pain, which is evaluated by using a questionnaire. In addition, LPP group was divided into 5 subgroups based on the types of pain, and the differences between the groups were also investigated by using a one way ANOVA.

RESULTS

Rotational asymmetry was observed in movement of the roll direction of the LPP patients. The DA of the roll angle of the LPP group was significantly greater than that in the pain free group (0.140 ± 0.093 vs. 0.077 ± 0.053, respectively; p =  0.004). In the analysis of pain complications, the significant difference in DA of roll angle, and CV of yaw angle were observed.

SIGNIFICANCE

The results indicated that motion asymmetry of both rotation and translation increased significantly in LPP patients' gait.

Relationship between gait kinematics and walking energy expenditure during pregnancy in South African women

Background

Various musculoskeletal changes occurring during pregnancy may lead to the change in gait and contribute to the increase in walking energy expenditure. Previous research indicates that changes in gait mechanics may lead to the increase in mechanical work required during walking. However, there is little information to indicate if changes in gait mechanics during pregnancy have impact on active or total energy expenditure. Therefore, the primary aim of this study was to investigate the relationship between changes in gait kinematics and walking energy expenditure in pregnant women.

Methods

Thirty-five women (mean age = 27.5 ± 6.1 years) volunteered for the study during various stages of pregnancy (1st trimester average = 12.1 ± 2.2 weeks; 2nd trimester = 22.3 ± 2.6 weeks; 3rd trimester = 31.4 ± 2.6 weeks). 3D motion analysis was used to assess changes in kinematic parameters during walking at self-selected pace. Resting metabolic rate, and walking energy expenditure expressed in terms of rate and cost of O₂ were analysed with portable metabolic analyser.

Results

Only medio-lateral deviation of centre of gravity (COG_ML) increased 13.6% between the 1st and 2nd, and 39.3% between 2nd and 3rd trimester (p ≤ 0.001). However, self-selected walking speed depicted strong significant positive linear relationship with net O₂ rate (r = 0.70; p ≤ 0.001), and was strongly associated with the vertical excursion of the COG (r = 0.75, p ≤ 0.001).

Conclusions

Changes in gait mechanics during pregnancy may lead to an increase in walking energy expenditure. However, the consequent increase in walking energy cost may not be sufficient to offset the natural energy sparing mechanism.

Gait assessment of the expectant mothers - Systematic review

INTRODUCTION

Since pregnant women may have potentially greater difficulty maintaining balance, their stability has been investigated by some researchers. However, there is no consensus considering the results. The purpose of our investigation was to compare all the experimental studies focusing on the analysis of gait that have been conducted over the last years to assess their methodological issues and changes induced by pregnancy.

METHODS

The PRISMA Guidelines incorporating a risk of bias and strength of recommendations were used as a methodological template for this review. Literature searches were conducted using the following databases: PubMed, Embase, SPORTDiscus, Scopus. After limiting the search to meet the inclusion criteria, 25 articles remained in the final analysis.

RESULTS

Some authors emphasised that adaptations due to pregnancy are recognised to provide safety and stability. Thus, they consistently reported reduced walking velocity as a result of lower frequency and smaller length of the steps. Longer contact times were reflected by the shortened peak forces. Plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. Another adjustment was an increase of base of support to improve lateral gait stability which allows to compensate increased medio-lateral ground reaction force. During the course of pregnancy the increase of anterior body mass and hormonal changes enhance some realignments of the pelvis and lumbar spine. Methodological approaches varied across the included studies. The critical appraisal identified some areas of weaknesses that should be considered for designing the future investigations.

CONCLUSIONS

Since many gait parameters are interrelated, in order to understand the cause-and-effect relationships an integrative and complete analysis of multiple factors is required.

Sexual Dimorphism and the Origins of Human Spinal Health

Recent observations indicate that the cross-sectional area (CSA) of vertebral bodies is on average 10% smaller in healthy newborn girls than in newborn boys, a striking difference that increases during infancy and puberty and is greatest by the time of sexual and skeletal maturity. The smaller CSA of female vertebrae is associated with greater spinal flexibility and could represent the human adaptation to fetal load in bipedal posture. Unfortunately, it also imparts a mechanical disadvantage that increases stress within the vertebrae for all physical activities. This review summarizes the potential endocrine, genetic, and environmental determinants of vertebral cross-sectional growth and current knowledge of the association between the small female vertebrae and greater risk for a broad array of spinal conditions across the lifespan.

Pregnancy and Pelvic Girdle PainAnalysis of Center of Pressure During Gait

BACKGROUND

A woman's body undergoes many changes during pregnancy, and it adapts by developing compensatory strategies, which can be sources of pain. We sought to analyze the effects of pregnancy and pelvic girdle pain (PGP) on center of pressure (COP) parameters during gait at different speeds.

METHODS

Sixty-one healthy pregnant women, 66 women with PGP between 18 and 27 weeks of pregnancy, and 22 healthy nonpregnant women walked at different velocities (slow, preferential, and fast) on a walkway with built-in pressure sensors. An analysis of variance was performed to determine the effects of gait speed and group on COP parameters.

RESULTS

In healthy pregnant women and women with PGP, COP parameters were significantly modified compared with those in nonpregnant women (P < .01). Support time was increased regardless of gait speed, and anteroposterior COP displacement was significantly decreased for women with PGP compared with healthy pregnant women. In addition, mediolateral COP displacement was significantly decreased in pregnant women compared with nongravid women.

CONCLUSIONS

Gait speed influenced COP displacement and velocity parameters, and gait velocity potentiated the effect of pregnancy on the different parameters. Pelvic girdle pain had an influence on COP anteroposterior length only. With COP parameters being only slightly modified by PGP, the gait of pregnant women with PGP was similar to that of healthy pregnant women but differed from that of nonpregnant women.

People With Chronic Neck Pain Walk With a Stiffer Spine

Study Design Controlled laboratory study, case-control design. Objective To evaluate spine kinematics and gait characteristics in people with nonspecific chronic neck pain. Background People with chronic neck pain present with a number of sensorimotor and biomechanical alterations, yet little is known about the influence of neck pain on gait and motions of the spine during gait. Methods People with chronic nonspecific neck pain and age- and sex-matched asymptomatic controls walked on a treadmill at 3 different speeds (self-selected, 3 km/h, and 5 km/h), either with their head in a neutral position or rotated 30°. Tridimensional motion capture was employed to quantify body kinematics. Neck and trunk rotations were derived from the difference between the transverse plane component of the head and thorax and thorax and pelvis angles to provide an indication of neck and trunk rotation during gait. Results Overall, the patient group showed shorter stride length compared to the control group (P<.001). Moreover, the patients with neck pain showed smaller trunk rotations (P<.001), regardless of the condition or speed. The difference in the amount of trunk rotation between groups became larger for the conditions of walking with the head rotated. Conclusion People with chronic neck pain walk with reduced trunk rotation, especially when challenged by walking with their head positioned in rotation. Reduced rotation of the trunk during gait may have long-term consequences on spinal health. J Orthop Sports Phys Ther 2017;47(4):268-277. Epub 3 Feb 2017. doi:10.2519/jospt.2017.6768.

Adaptive changes in spatiotemporal gait characteristics in women during pregnancy

Spatiotemporal gait cycle characteristics were assessed at early (P1), and late (P2) pregnancy, as well as at 2 months (PP1) and 6 months (PP2) postpartum. A substantial decrease in walking speed was observed throughout the pregnancy, with the slowest speed (1±0.2m/s) being during the third trimester. Walking at slower velocity resulted in complex adaptive adjustments to their spatiotemporal gait pattern, including a shorter step length and an increased duration of both their stance and double-support phases. Duration of the swing phase remained the least susceptible to changes. Habitual walking velocity (1.13±0.2m/s) and the optimal gait pattern were fully recovered 6 months after childbirth. Documented here adaptive changes in the preferred gait pattern seem to result mainly from the altered body anthropometry leading to temporary balance impairments. All the observed changes within stride cycle aimed to improve gait safety by focusing on its dynamic stability. The pregnant women preferred to walk at a slower velocity which allowed them to spend more time in double-support compared with their habitual pattern. Such changes provided pregnant women with a safer and more tentative ambulation that reduced the single-support period and, hence, the possibility of instability. As pregnancy progressed a significant increase in stance width and a decrease in step length was observed. Both factors allow also for gait stability improvement.

The association between pelvic girdle pain and sick leave during pregnancy; a retrospective study of a Norwegian population

Background

The incidence of pelvic girdle pain (PGP) in pregnancy is wide ranged depending on definition, the utilised diagnostic means, and the design of the studies. PGP during pregnancy has negative effects on activities of daily living and causes long sick leave, which makes it a major public health issue. Our objectives were to explore the frequency of sick leave in pregnancy due to PGP, assess the relationship between different types of pain-related activities of daily living, examine physical workload, type of work in relation to sick leave, and to explore factors that make women less likely to take sick leave for PGP.

Methods

All women giving birth at the maternity ward of Stavanger University Hospital, Norway, were asked to participate and complete a questionnaire on demographic features, PGP, pain-related activities of daily living, sick leave in general and for PGP, frequency of exercising before and during pregnancy. Drawings of pelvic girdle and low back area were used for the localization of pain. PGP intensity was then rated retrospectively on a numerical rating scale. Non-parametric tests, multinomial logistic regression and sequential linear regression analysis were used in the statistical analysis.

Results

PGP is a frequent and major cause of sick leave during pregnancy among Norwegian women, which is also reflected in activities of daily living as measured with scores on all Oswestry disability index items. In the multivariate analysis of factors related to sick leave and PGP we found that work satisfaction, problems with lifting and sleeping, and pain intensity were risk factors for sick leave. In addition, women with longer education, higher work satisfaction and fewer problems with sitting, walking and standing, were less likely to take sick leave in pregnancy, despite the same pain intensity as women being on sick leave.

Conclusions

A coping factor in pregnant women with PGP was discovered, most likely dependant on education, associated with work situation and/or work posture, which decreases sick leave. We recommend these issues to be further examined in a prospective longitudinal study since it may have important implications for sick leave frequency during pregnancy.

Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women

[Purpose] The aim of this study was to investigate the changes in pain intensity, spinal curvature, and balance and gait ability according to the pregnancy period. [Subjects] Nineteen pregnant women and fifteen nonpregnant women were recruited in this study. [Methods] The pain intensity, spinal curvature, gait, and balance of pregnant women were measured according to the pregnant period (2nd and 3rd trimester). The changes in the pregnant women were also compared with those in the nonpregnant women. [Results] The pain intensity and spinal curvature in the third trimester of pregnancy were significantly increased compared with the second trimester. Only the lumbar spine curvature in the third trimester pregnancy was significantly greater in the pregnant women than in non-pregnant women. The gait velocity and cadence in the third trimester of pregnancy showed a significant decrease compared with the second trimester. The gait speed in the second and third trimester of pregnancy showed a significant decrease in the pregnant women compared with nonpregnant women. Balance in the third trimester of pregnancy showed significant improvement compared with the second trimester. The balance of the pregnant women showed a significant decrease compare with that nonpregnant women only on unstable surfaces. [Conclusion] These research findings can be used as basic data for health promotion programs for sound daily activities in pregnant women.

Reliability of the Timed Up and Go test and Ten-Metre Timed Walk Test in Pregnant Women with Pelvic Girdle Pain

BACKGROUND AND PURPOSE

There is a lack of functional objective tests available to measure functional status in women with pelvic girdle pain (PGP). The purpose of this study was to establish test-retest and intertester reliability of the Timed Up and Go (TUG) test and Ten-metre Timed Walk Test (10mTWT) in pregnant women with PGP.

METHODS

A convenience sample of women was recruited over a 4-month period and tested on two occasions, 1 week apart to determine test-retest reliability. Intertester reliability was established between two assessors at the first testing session. Subjects were instructed to undertake the TUG and 10mTWT at maximum speed. One practise trial and two timed trials for each walking test was undertaken on Day 1 and one practise trial and one timed trial on Day 2.

RESULTS

Seventeen women with PGP aged 31.1 years (SD [standard deviation] = 2.3) and 28.7 weeks pregnant (SD = 7.4) completed gait testing. Test-retest reliability using the intraclass correlation coefficient (ICC) was excellent for the TUG (0.88) and good for the 10mTWT (0.74). Intertester reliability was determined in the first 13 participants with excellent ICC values being found for both walking tests (TUG: 0.95; 10mTWT: 0.94).

CONCLUSION

This study demonstrated that the TUG and 10mTWT undertaken at fast pace are reliable, objective functional tests in pregnant women with PGP. While both tests are suitable for use in the clinical and research settings, we would recommend the TUG given the findings of higher test-retest reliability and as this test requires less space and time to set up and score. Future studies in a larger sample size are warranted to confirm the results of this study.

Pelvic step: the contribution of horizontal pelvis rotation to step length in young healthy adults walking on a treadmill

Transverse plane pelvis rotations during walking may be regarded as the "first determinant of gait". This would assume that pelvis rotations increase step length, and thereby reduce the vertical movements of the centre of mass-"the pelvic step". We analysed the pelvic step using 20 healthy young male subjects, walking on a treadmill at 1-5 km/h, with normal or big steps. Step length, pelvis rotation amplitude, leg-pelvis relative phase, and the contribution of pelvis rotation to step length were calculated. When speed increased in normal walking, pelvis rotation changed from more out-of-phase to in-phase with the upper leg. Consequently, the contribution of pelvis rotation to step length was negative at lower speeds, switching to positive at 3 km/h. With big steps, leg and pelvis were more in-phase, and the contribution of pelvis rotation to step length was always positive, and relatively large. Still, the overall contribution of pelvis rotations to step length was small, less than 3%. Regression analysis revealed that leg-pelvis relative phase predicted about 60% of the variance of this contribution. The results of the present study suggest that, during normal slow walking, pelvis rotations increase, rather than decrease, the vertical movements of the centre of mass. With large steps, this does not happen, because leg and pelvis are in-phase at all speeds. Finally, it has been suggested that patients with hip flexion limitation may use larger pelvis rotations to increase step length. This, however, may only work as long as the pelvis rotates in-phase with the leg.

Reliability and validity of spinal coordination patterns during treadmill walking in persons with thoracic spine pain--a preliminary study

Background

Persons with low back pain fail to show the same transition as healthy individuals from in-phase to anti-phase rotation of the thorax and pelvis as walking speed increases. The purpose of this study was to determine if the relative phase of the thorax and pelvis during walking was a reliable (within day test-retest) and valid measure for persons with thoracic pain.

Methods

The time series motion of the spine over C7, T8 and sacrum were measured at five treadmill walking speeds (0.67, 0.89, 1.12, 1.34, 1.56 m/s) in 19 persons with thoracic spine pain and 19 healthy control subjects. After a 20 minute rest, all tests were repeated. The average relative phases of the transverse plane rotation between C7-T8, C7-sacrum and T8-sacrum during a one-minute walk were calculated. The standard error of measurement (SEM) and the intra-class correlation coefficient (ICC) were used to estimate test-retest reliability. Three-way repeated measures analyses of variance were performed to determine the influence of group, walking speed and session on the relative phases.

Results

The minimum transverse plane motion amplitudes, across all participants and speeds, for the C7-T8, C7-sacrum, and T8-sacrum were 2.9, 5.1 and 2.8 degrees, respectively. The C7-T8 relative phase changed little with speed. The C7-sacrum and T8-sacrum relative phases showed increases as subjects walked faster, but both groups had similar patterns of change. Only the C7-T8 relative phase at 0.67 and 0.89 m/s exhibited good reliability (ICC > 0.80, SEM 4.2-5.7, no significant time effects) for both groups. The C7-T8 and T8-sacrum relative phases demonstrated significant group by speed effects.

Conclusions

The C7-T8 relative phase showed reasonable reliability and some discrimination between groups, but changes in response to walking speed were small. The T8-sacrum relative phase showed some discriminative ability, but reliability was not adequate.

Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review

PURPOSE

To determine the level of evidence for altered mechanical and motor control of the pelvis being associated with pregnancy-related pelvic girdle pain (PPGP).

METHODS

This systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six different databases were used for the electronic search. Observational cohorts, cross sectional or case-control studies focused on the association between altered kinematic/kinetic and motor control of the pelvis and PPGP during pregnancy were included. Study selection was conducted by two reviewers who firstly screened for titles, then for abstracts and finally for full articles. The Newcastle-Ottawa scale and the guidelines proposed by the Cochrane back review group were used to assess risk of bias and quality of evidence, respectively.

RESULTS

354 references were identified, and after excluding unwanted articles, 10 studies met the final inclusion criteria. Studies not related to motor control or pelvic mobility were the main reason for exclusion. Seven studies were case-control and three were prospective cohort studies. Seven studies were ranked as high while three were ranked as low quality. Among the high quality studies, six found association between PPGP and altered motor control and mobility of the pelvis.

CONCLUSIONS

The level of evidence for an association between PPGP and altered motor control and kinematic or kinetic parameters of the pelvis was found to be moderate.

Association between the serum levels of relaxin and responses to the active straight leg raise test in pregnancy

There is a common belief that the laxity of pelvic joints increases in pregnancy. The hormone relaxin is suggested to be one of the most influential factors implementing this effect. Furthermore, increased laxity is assumed to induce pelvic girdle pain (PGP). The objectives were to examine the serum relaxin levels in pregnancy and to investigate whether relaxin levels relate to symptoms and clinical tests for PGP. Data from questionnaires, clinical tests and blood samples were collected once in pregnancy (gestation week 5-24) from 212 women. Serum from blood samples were analyzed by ELIZA to determine the concentration of relaxin. Self reported symptoms were assessed by Disability Rating Index (DRI) and pain intensity (VAS). Clinical examinations included Active Straight Leg Raise (ASLR) test and pain provocation tests. ANOVA was used to assess the effect of gestation age and multivariable statistics to examine the association between relaxin levels and the symptoms or responses to clinical tests. The serum levels of relaxin varied widely between individuals and were only marginally influenced by the gestation age. There was no association between gestation age and responses to clinical tests or pain intensity, but DRI increased with gestation age. Serum concentration of relaxin showed a significant association to positive score on the ASLR test, but no significant associations to responses to pain provocation tests, pain intensity or DRI. The results indicate that relaxin contributes to laxity of pelvic joints in pregnancy. Yet, no evidence of relaxin having an impact on symptoms or perceived disability was found.

Mechanical coupling between transverse plane pelvis and thorax rotations during gait is higher in people with low back pain

This study investigated whether people with low back pain (LBP) reduce variability of movement between the pelvis and thorax (trunk) in the transverse plane during gait at different speeds compared to healthy controls. Thirteen people with chronic LBP and twelve healthy controls walked on a treadmill at speeds from 0.5 to 1.72 m/s, with increments of 0.11 m/s. Step-to-step variability of the trunk, pelvis, and thorax rotations were calculated. Step-to-step deviations of pelvis and thorax rotations from the average pattern (residual rotations) were correlated to each other, and the linear regression coefficients between these deviations calculated. Spectral analysis was used to determine the frequencies of the residual rotations, to infer the relation of reduced trunk variability to trunk stiffness and/or damping. Variability of trunk motion (thorax relative to pelvis) was lower (P=0.02), covariance between the residual rotations of pelvis and thorax motions was higher (P=0.03), and the linear regression coefficients were closer to 1 (P=0.05) in the LBP group. Most power of segmental residual rotations was below stride frequency (~1 Hz). In this frequency range, trunk residual rotations had less power than pelvis or thorax residual rotations. These data show that people with LBP had lower variability of trunk rotations, as a result of the coupling of deviations of residual rotations in one segment to deviations of a similar shape (correlation) and amplitude (regression coefficient) in the other segment. These results support the argument that people with LBP adopt a protective movement strategy, possibly by increased trunk stiffness.

Pelvis-shoulder coordination during level walking in patients with ankylosing spondylitis

Pelvis-shoulder coordination while walking may, as a consequence of changes in spinal structure and posture, be susceptible to modifications in ankylosing spondylitis (AS) sufferers. We designed an explanatory, cross-sectional trial to assess whether Pelvis-shoulder coordination during walking in AS patients differs from that in healthy subjects. Seventeen AS patients and 10 healthy sex- and age-matched subjects were enrolled. Gait analysis was performed in order to define the time-distance and kinematic characteristics during walking. Pelvis-shoulder coordination was calculated in terms of the continuous estimate of relative phase (CRP) between the pelvis and shoulder girdles on the transversal plane for the whole gait cycle (GC), as well as for its sub-phases. No differences were found between patients and controls as regards mean velocity, cadence and stride length. When kinematic variables were compared with those of healthy controls, AS patients displayed greater pelvic tilt and increased hip flexion in both the loading response (LR) and pre-swing (PSw) sub-phases. The CRP mean values significantly differed between groups. Moreover, patients displayed a peculiar CRP pattern, chiefly in the LR, terminal stance and PSw sub-phases. This visual consideration was confirmed by the analysis of the CRP mean values in these sub-phases of the GC. Our results suggest that the walking pattern of AS patients is characterized by altered Pelvis-shoulder coordination during the GC.

Pregnancy-related pelvic girdle pain: an update

A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women.

Gait adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing

Patients with chronic non-specific low back pain (LBP) walk with more synchronous (in-phase) horizontal pelvis and thorax rotations than controls. Low thorax–pelvis relative phase in these patients appears to result from in-phase motion of the thorax with the legs, which was hypothesized to affect arm swing. In the present study, gait kinematics were compared between LBP patients with lumbar disc herniation and healthy controls during treadmill walking at different speeds and with different step lengths. Movements of legs, arms, and trunk were recorded. The patients walked with larger pelvis rotations than healthy controls, and with lower relative phase between pelvis and thorax horizontal rotations, specifically when taking large steps. They did so by rotating the thorax more in-phase with the pendular movements of the legs, thereby limiting the amplitudes of spine rotation. In the patients, arm swing was out-of phase with the leg, as in controls. Consequently, the phase relationship between thorax rotations and arm swing was altered in the patients.