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Alshehri MA, van den Hoorn W, Klyne DM, van Dieën JH, Cholewicki J, Hodges PW. Poor lumbar spine coordination in acute low back pain predicts persistent long-term pain and disability. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2380-2394. [PMID: 38483640 DOI: 10.1007/s00586-024-08205-w] [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: 10/13/2023] [Revised: 12/22/2023] [Accepted: 02/23/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Sitting balance on an unstable surface requires coordinated out-of-phase lumbar spine and provides sufficient challenge to expose quality of spine control. We investigated whether the quality of spine coordination to maintain balance in acute low back pain (LBP) predicts recovery at 6 months. METHODS Participants in an acute LBP episode (n = 94) underwent assessment of sitting balance on an unstable surface. Seat, hip and spine (lower lumbar, lumbar, upper lumbar, thoracic) angular motion and force plate data were recorded. Coordination between the seat and hip/spine segments to maintain balance was quantified in the frequency domain to evaluate coordination (coherence) and relative timing (phase angle: in-phase [segments move together]; out-of-phase [segments move opposite]). Center of pressure (CoP) and upper thorax motion assessed overall balance performance. Hip and spine coordination with the seat were compared between those who did not recover (increased/unchanged pain/disability), partially recovered (reduced pain/disability) or recovered (no pain and disability) at 6 months. RESULTS In both planes, coherence between the seat and lower lumbar spine was lower (and in-phase-unhelpful for balance) at baseline in those who did not recover than those who recovered. Coherence between the seat and hip was higher in partially recovered in both planes, suggesting compensation by the hip. LBP groups had equal overall balance performance (CoP, upper thorax motion), but non-recovery groups used a less optimal strategy that might have consequences for long-term spine health. CONCLUSION These longitudinal data revealed that individuals with compromised contribution of the lumbar spine to the balance during unstable sitting during acute LBP are less likely to recover.
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Affiliation(s)
- Mansour Abdullah Alshehri
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Wolbert van den Hoorn
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - David M Klyne
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jacek Cholewicki
- Center for Neuromusculoskeletal Clinical Research, Michigan State University, Lansing, MI, USA
- Department of Osteopathic Manipulative Medicine, Michigan State University, East Lansing, MI, USA
| | - Paul W Hodges
- The University of Queensland, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia.
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van Dieën JH, Kistemaker DA. Increased velocity feedback gains in the presence of sensory noise can explain paradoxical changes in trunk motor control related to back pain. J Biomech 2024; 162:111876. [PMID: 37989619 DOI: 10.1016/j.jbiomech.2023.111876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
Literature reports paradoxical findings regarding effects of low-back pain (LBP) on trunk motor control. Compared to healthy individuals, patients with LBP, especially those with high pain-related anxiety, showed stronger trunk extensor reflexes and more resistance against perturbations. On the other hand, LBP patients and especially those with high pain-related anxiety showed decreased precision in unperturbed trunk movement and posture. These paradoxical effects might be explained by arousal potentially increasing average and variance of muscle spindle firing rates. Increased average firing rates could increase resistance against perturbations, but increased variance could decrease precision. We performed a simulation study to test this hypothesis. We modeled the trunk as a 2D inverted pendulum, stabilized by two antagonistic Hill-type muscles, based on their open-loop muscle activation dependent intrinsic stiffness and damping and through 25 ms-delayed, noisy contractile element length and velocity feedback. Reference feedback gains and sensory noise levels were tuned based on previously reported experimental data. We assessed the effect of increasing feedback gains on precision of trunk orientation at different perturbation magnitudes and assessed sensitivity of the effects to open-loop muscle stimulation and noise levels. At low perturbation magnitudes, increasing reflex gains consistently caused an increase in the variance of trunk orientation. At larger perturbation magnitudes, increasing reflex gains consistently caused a decrease in the variance of trunk orientation. Our results support the notion that LBP and related anxiety may increase reflex gains, resulting in an increase in the average and variance of spindle afference, which in turn increase resistance against perturbations and decrease movement precision.
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Affiliation(s)
- Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Dinant A Kistemaker
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Wildenbeest MH, Kiers H, Tuijt M, Prins MR, van Dieën JH. Trunk resistance to mechanical perturbations, associations with low back pain, pain-related cognitions and movement precision. Hum Mov Sci 2023; 92:103159. [PMID: 37979472 DOI: 10.1016/j.humov.2023.103159] [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: 08/15/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Pain-related cognitions are associated with motor control changes in people with chronic low-back pain (CLBP). The mechanism underlying this association is unclear. We propose that perceived threat increases muscle-spindle-reflex-gains, which reduces the effect of mechanical perturbations, and simultaneously decreases movement precision. AIM To evaluate effects of CLBP and pain-related cognitions on the impact of mechanical perturbations on trunk movement, and associations between these perturbation effects and movement precision. METHODS 30 participants with CLBP and 30 healthy controls, performed two consecutive trials of a seated repetitive reaching task. During both trials participants were warned for mechanical perturbations, which were only administered during the second trial. The perturbation effect was characterized by the deviation of the trajectory of the T8 vertebra relative to the sacrum. Trunk movement precision was expressed as tracking error during a trunk movement target tracking task. We assessed pain-related cognitions with the task-specific 'Expected Back Strain'-scale (EBS). We used a two-way-Anova to assess the effect of Group (CLBP vs back-healthy) and dichotomized EBS (higher vs lower) on the perturbation effect, and a Pearson's correlation to assess associations between perturbation effects and movement precision. FINDINGS Higher EBS was associated with smaller perturbation effects (p ≤ 0.011). A negative correlation was found between the perturbation effect and the tracking error, in the higher EBS-group (r = -0.5, p = 0.013). INTERPRETATION These results demonstrate that pain-related cognitions influence trunk movement control and support the idea that more negative pain-related cognitions lead to an increased resistance against perturbations, at the expense of movement precision.
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Affiliation(s)
- Meta H Wildenbeest
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands.
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands
| | - Matthijs Tuijt
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Maarten R Prins
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, the Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands
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Abu Bakar F, Staal JB, van Cingel R, Saito H, Ostelo R, van Dieën JH. Not all movements are equal: Differences in the variability of trunk motor behavior between people with and without low back pain-A systematic review with descriptive synthesis. PLoS One 2023; 18:e0286895. [PMID: 37682939 PMCID: PMC10490924 DOI: 10.1371/journal.pone.0286895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/02/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Differences in variability of trunk motor behavior between people with and without low back pain (LBP) have been reported in the literature. However, the direction and consistency of these differences remain unclear. Understanding variability of trunk motor behavior between individuals with LBP and those without is crucial to better understand the impact of LBP and potentially optimize treatment outcomes. Identifying such differences may help tailor therapeutic interventions. OBJECTIVE This systematic review aims to answer the question: Is variability of trunk motor behavior different between people with and without LBP and if so, do people with LBP show more or less variability? Furthermore, we addressed the question whether the results are dependent on characteristics of the patient group, the task performed and the type of variability measure. METHODS This study was registered in PROSPERO (CRD42020180003). A comprehensive systematic literature search was performed by searching PubMed, Embase, Cinahl, Cochrane Central Register of Controlled Trials, Web of Science and Sport Discus. Studies were eligible if they (1) included a LBP group and a control group, (2) included adults with non-specific low back pain of any duration and (3) measured kinematic variability, EMG variability and/or kinetic variability. Risk of Bias was evaluated and a descriptive synthesis was performed. RESULTS Thirty-nine studies were included, thirty-one of which were included in the descriptive synthesis. In most studies and experimental conditions, variability did not significantly differ between groups. When significant differences were found, less variability in patients with LBP was more frequently reported than more variability, especially in gait-related tasks. CONCLUSIONS Given the considerable risk of bias of the included studies and the clinical characteristics of the participants with low severity scores for pain, disability and psychological measures, there is insufficient evidence to draw firm conclusions.
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Affiliation(s)
- Florian Abu Bakar
- Han University of Applied Sciences, Research Group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
| | - J. Bart Staal
- Han University of Applied Sciences, Research Group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Robert van Cingel
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
- Sports Medical Centre Papendal, Arnhem, The Netherlands
| | - Hiroki Saito
- Department of Physical Therapy, Tokyo University of Technology, Tokyo, Japan
| | - Raymond Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Jaap H. van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Park J, Nguyen VQ, Ho RLM, Coombes SA. The effect of chronic low back pain on postural control during quiet standing: A meta-analysis. Sci Rep 2023; 13:7928. [PMID: 37193730 DOI: 10.1038/s41598-023-34692-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Low back pain (LBP) has been associated with altered body sway during quiet standing, but the pattern of results is inconsistent. The purpose of this meta-analysis is to examine the effects of vision (eyes open, eyes closed) and changing the support surface (foam surface, firm surface) on postural sway during quiet standing in individuals with chronic LBP (cLBP). Five electronic databases were searched on March 27th, 2022. Of 2,856, 16 studies (n = 663) were included. Across all conditions, we found a positive and medium effect size (g = 0.77 [0.50, 1.04]) that represented greater body sway in individuals with cLBP. Subgroup analyses revealed medium effects during eyes open conditions (firm surface: g = 0.60 [0.33, 0.87]; foam surface: g = 0.68 [0.38, 0.97]), and large effects during eyes closed conditions (firm surface: g = 0.97 [0.60, 1.35]; foam surface: g = 0.89 [0.28, 1.51]). We quantified effects of self-reported pain and found a moderate effect during eyes closed plus firm surface conditions (Q = 3.28; p = 0.070). We conclude that cLBP is associated with increased postural sway, with largest effect sizes evident when vision is removed and when self-reported pain intensity is higher.
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Affiliation(s)
- Jinhan Park
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA
| | - Vinh Q Nguyen
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA
| | - Rachel L M Ho
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118206, Gainesville, FL, 32611, USA.
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, 32611, USA.
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Wildenbeest MH, Kiers H, Tuijt M, van Dieën JH. Effect of postural threat on motor control in people with and without low back pain. PLoS One 2023; 18:e0280607. [PMID: 36972228 PMCID: PMC10042370 DOI: 10.1371/journal.pone.0280607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Negative pain-related cognitions are associated with persistence of low-back pain (LBP), but the mechanism underlying this association is not well understood. We propose that negative pain-related cognitions determine how threatening a motor task will be perceived, which in turn will affect how lumbar movements are performed, possibly with negative long-term effects on pain. OBJECTIVE To assess the effect of postural threat on lumbar movement patterns in people with and without LBP, and to investigate whether this effect is associated with task-specific pain-related cognitions. METHODS 30 back-healthy participants and 30 participants with LBP performed consecutive two trials of a seated repetitive reaching movement (45 times). During the first trial participants were threatened with mechanical perturbations, during the second trial participants were informed that the trial would be unperturbed. Movement patterns were characterized by temporal variability (CyclSD), local dynamic stability (LDE) and spatial variability (meanSD) of the relative lumbar Euler angles. Pain-related cognition was assessed with the task-specific 'Expected Back Strain'-scale (EBS). A three-way mixed Manova was used to assess the effect of Threat, Group (LBP vs control) and EBS (above vs below median) on lumbar movement patterns. RESULTS We found a main effect of threat on lumbar movement patterns. In the threat-condition, participants showed increased variability (MeanSDflexion-extension, p<0.000, η2 = 0.26; CyclSD, p = 0.003, η2 = 0.14) and decreased stability (LDE, p = 0.004, η2 = 0.14), indicating large effects of postural threat. CONCLUSION Postural threat increased variability and decreased stability of lumbar movements, regardless of group or EBS. These results suggest that perceived postural threat may underlie changes in motor behavior in patients with LBP. Since LBP is likely to impose such a threat, this could be a driver of changes in motor behavior in patients with LBP, as also supported by the higher spatial variability in the group with LBP and higher EBS in the reference condition.
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Affiliation(s)
- Meta H Wildenbeest
- Institute for Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Tuijt
- Institute for Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Vatovec R, Kozinc Ž, Šarabon N. Trunk strength and range of motion in adolescent basketball, soccer and tennis players with and without low back pain history. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2022. [DOI: 10.1007/s12662-022-00857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Varrecchia T, Conforto S, De Nunzio AM, Draicchio F, Falla D, Ranavolo A. Trunk Muscle Coactivation in People with and without Low Back Pain during Fatiguing Frequency-Dependent Lifting Activities. SENSORS 2022; 22:s22041417. [PMID: 35214319 PMCID: PMC8874369 DOI: 10.3390/s22041417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 01/31/2023]
Abstract
Lifting tasks are manual material-handling activities and are commonly associated with work-related low back disorders. Instrument-based assessment tools are used to quantitatively assess the biomechanical risk associated with lifting activities. This study aims at highlighting different motor strategies in people with and without low back pain (LBP) during fatiguing frequency-dependent lifting tasks by using parameters of muscle coactivation. A total of 15 healthy controls (HC) and eight people with LBP performed three lifting tasks with a progressively increasing lifting index (LI), each lasting 15 min. Bilaterally erector spinae longissimus (ESL) activity and rectus abdominis superior (RAS) were recorded using bipolar surface electromyography systems (sEMG), and the time-varying multi-muscle coactivation function (TMCf) was computed. The TMCf can significantly discriminate each pair of LI and it is higher in LBP than HC. Collectively, our findings suggest that it is possible to identify different motor strategies between people with and without LBP. The main finding shows that LBP, to counteract pain, coactivates the trunk muscles more than HC, thereby adopting a strategy that is stiffer and more fatiguing.
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Affiliation(s)
- Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Rome, Italy; (T.V.); (F.D.); (A.R.)
- Department of Industrial, Electronic and Mechanical Engineering, Roma Tre University, 00146 Rome, Italy
| | - Silvia Conforto
- Department of Industrial, Electronic and Mechanical Engineering, Roma Tre University, 00146 Rome, Italy
- Correspondence:
| | - Alessandro Marco De Nunzio
- Department of Sport and Exercise Science, LUNEX International University of Health, Exercise and Sports, 4671 Luxembourg, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 4671 Luxembourg, Luxembourg
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Rome, Italy; (T.V.); (F.D.); (A.R.)
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Rome, Italy; (T.V.); (F.D.); (A.R.)
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