Effect of chronic idiopathic low back pain on the kinetic gait characteristics in different foot masks

Do people with low back pain walk differently? A systematic review and meta-analysis

BACKGROUND

The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.

METHODS

A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between back pain and back-healthy control groups.

RESULTS

Ninety-seven studies were included and reviewed. Two studies investigated acute pain and the rest investigated persistent pain. Nine studies investigated running gait. Of the studies, 20% had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent LBP walked slower (SMD = -0.59, 95% confidence interval (95%CI): -0.77 to -0.42)) and with shorter stride length (SMD = -0.38, 95%CI: -0.60 to -0.16). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups (SMD = -0.60, 95%CI: -0.90 to -0.30), and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles (SMD = 0.52, 95%CI: 0.23-0.80). There were no consistent differences in running biomechanics between groups.

CONCLUSION

There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.

Fear-avoidance beliefs, anxiety and depression are associated with motor control and dynamics parameters in patients with chronic low back pain

PURPOSE

To evaluate the influence of fear-avoidance beliefs, anxiety and depression on dynamic and motor control parameters before and after Functional Restoration Program.

METHODS

Patients were divided into three groups depending on clinical scores scores. Dynamic and motor control parameters were extracted from gait analysis.

RESULTS

Patients showed different ways based on preferred walking speed, capacity benefit, peaks of propulsion and gait stability in function of clinical scores.

CONCLUSION

Fear-avoidance beliefs associated to anxiety and depression influence biomechanics on overground walking. We depicted different ways to adapt their gait in function of biopsychosocial scores. Functional Restoration Program influence these ways.

A Case-Control Study of the Effects of Chronic Low Back Pain in Spatiotemporal Gait Parameters

Chronic low back pain and biomechanical walking imbalances are closely related. It is relevant to identify if there are alterations in spatiotemporal gait patterns in subjects with CLBP (cases) versus healthy subjects (controls) to plan training interventions of motor control gait patterns, and thus allowing normal physical activity of the individual. This study is intended to identify if spatiotemporal alterations occur in the gait cycle in CLBP subjects (cases) compared with a control group (healthy patients) analyzed with an OptoGait LED sensors gait program. Method: A total of n = 147 participants: n = 75 cases (CLBP) and n = 72 healthy controls subjects were studied with OptoGait gait program. Results: Significant differences were found between the two groups and both feet in foot stride, for the differences of the total stride and contact, for gait cadence and total stride length of the gait cycle (p < 0.05). Conclusions: CLBP may alter some normal gait patterns measured by OptoGait; this finding presents imbalances in gait cycle as an underlying factor. The gait is part of daily life of any individual and it is an important physical activity in relation to the maintenance of an optimal state of health. In addition, future studies are deemed necessary.

Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment

Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.

Effect of trunk muscles fatigue on plantar pressure distribution in novice runners

During running, trunk muscles act to sufficiently contribute to the energy generation and transmission of the body parts. Improper function of trunk muscles affects running mechanics adversely and could result in altered lower limb energetics. The aim of this study was to examine the effects of trunk muscles fatigue on plantar pressure distribution in novice runners. 46 novice heel-to-toe runners (26 female and 20 male) ran in 3.3 m/s before and after the trunk muscles fatigue along the plantar pressure measuring device. Then, participants performed trunk muscles fatigue protocol. Trunk muscles fatigue protocol consisted of four consecutive cycles of seven exercises (1) rotating trunk with a medicine ball in sitting position, 2) prone static torso extension with a medicine ball, 3) rotate lower torso with a medicine ball in supine position, 4) incline sit-ups with a weight plate, 5) lateral side binding with a weight plate, 6) rotating lumbar extension with weighted plate, and 7) standing trunk rotation with weighted pulley resistant. After trunk muscles fatigue, increases in loading of lesser toes (p = 0.001, ES = 0.379), fourth (p = 0.001, ES = 0.474) and fifth metatarsals (p = 0.004, ES = 0.173) and medial and lateral heel (p = 0.018,0.001, ES = 0.118,0.427) were observed. Also, foot progression angle (p = 0.001, ES = 392) and relative time of initial contact phase (p = 0.003, ES = 0.182) decreased. The trunk muscles fatigue could alter the plantar pressure distribution pattern. Novice runners should consider strengthening of the trunk region muscles to avoid trunk muscles strength reduction-related changes in running mechanics.

Assessment instruments of movement quality in patients with non-specific low back pain: A systematic review and selection of instruments

BACKGROUND

Observing and analyzing movement quality (MQ) in patients with non-specific low back pain (NS-LBP) is important in the clinical reasoning of primary care physiotherapists and exercise therapists. However, there is no standardized form of assessment.

RESEARCH QUESTION

which MQ domains are measured with which instruments, and which activities are relevant, appropriate and methodologically sound for assessing MQ in patients with NS-LBP?

METHODS

The study had three phases. In phase 1 we conducted a systematic review in PubMed, CINAHL and SPORTDiscus of literature published until October 2018. The selected studies measured MQ domains with instruments that enabled us to 1) compare MQ in self-paced dynamic activities of patients with NS-LBP and healthy controls, and/or 2) determine change over time of MQ in patients with NS-LBP. In phase 2 we established relevant dynamic activities to assess in patients with NS-LBP. In phase 3 we determined appropriateness and methodological qualities of the selected instruments.

RESULTS

Thirty cross-sectional and three pre-post-test studies were eligible. The instruments consisted of complex (n = 19) and simple (n = 7) instrumented motion analysis systems and standardized observational tests (n = 7). We identified three domains representative for MQ: range of motion (ROM), inter-segmental coordination, and whole-body movements. In these domains, patients with NS-LBP significantly differed from healthy controls, respectively 7/12, 12/13 and 13/20 studies. Moreover, ROM and whole-body movements significantly improved over time in patients with NS-LBP (3/3 studies). Based on phase 3, we concluded that none of the instruments are appropriate to assess MQ in patients with NS-LBP in primary care.

SIGNIFICANCE

Forward bending, lifting, and walking seem the most relevant activities to evaluate in patients with NS-LBP. However, we found no suitable instruments to measure ROM, inter-segmental coordination, or whole-body movements as determinants of MQ in these activities in daily practice. We therefore recommend such an instrument be developed.