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Stamenkovic A, Clark BC, Pidcoe PE, van der Veen SM, France CR, Russ DW, Kinser PA, Thomas JS. Distinguishing chronic low back pain in young adults with mild to moderate pain and disability using trunk compliance. Sci Rep 2021; 11:7592. [PMID: 33828171 PMCID: PMC8026630 DOI: 10.1038/s41598-021-87138-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/24/2021] [Indexed: 11/09/2022] Open
Abstract
Chronic low back pain (cLBP) rates among younger individuals are rising. Although pain and disability are often less severe, underlying changes in trunk behavior may be responsible for recurrence. We examine the biomarker capacity of a simple Trunk Compliance Index (TCI) to distinguish individuals with and without cLBP. A random subset (n = 49) of the RELIEF RCT were matched to healthy controls for sex, age, height and weight. We measured TCI (as displacement/ weight-normalized perturbation force) using anthropometrically-matched, suddenly-applied pulling perturbations to the trunk segment, randomized across three planes of motion (antero-posterior, medio-lateral, and rotational). Mean differences between cLBP, sex and perturbation direction were assessed with repeated-measures analysis of variance. Discriminatory accuracy of TCI was assessed using Receiver Operator Characteristic (ROC) analysis. Baseline characteristics between groups were equivalent (x̅ [range]): sex (57% female / group), age (23.0 [18-45], 22.8 [18-45]), height, cm (173.0 [156.5-205], 171.3 [121.2-197], weight, kg (71.8 [44.5-116.6], 71.7 [46.8-117.5]) with cLBP associated with significantly lower TCI for 5 of 6 directions (range mean difference, - 5.35: - 1.49, range 95% CI [- 6.46: - 2.18 to - 4.35: - 0.30]. Classification via ROC showed that composite TCI had high discriminatory potential (area under curve [95% CI], 0.90 [0.84-0.96]), driven by TCI from antero-posterior perturbations (area under curve [95% CI], 0.99 [0.97-1.00]). Consistent reductions in TCI suggests global changes in trunk mechanics that may go undetected in classic clinical examination. Evaluation of TCI in younger adults with mild pain and disability may serve as a biomarker for chronicity, leading to improved preventative measures in cLBP.Trial Registration and Funding RELIEF is registered with clinicaltrials.gov (NCT01854892) and funded by the NIH National Center for Complementary & Integrative Health (R01AT006978).
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Affiliation(s)
- Alexander Stamenkovic
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA.
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, USA.,Department of Biomedical Sciences, Ohio University, Athens, USA
| | - Peter E Pidcoe
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA
| | - Susanne M van der Veen
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA.,Physical and Rehabilitation Medicine, Virginia Commonwealth University, Richmond, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, USA.,Department of Psychology, Ohio University, Athens, USA
| | - David W Russ
- School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, USA
| | | | - James S Thomas
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, 900 East Leigh St, 4th Floor, Richmond, VA, 23298, USA.,Physical and Rehabilitation Medicine, Virginia Commonwealth University, Richmond, USA
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van den Hoorn W, Cholewicki J, Coppieters MW, Klyne DM, Hodges PW. Trunk stiffness decreases and trunk damping increases with experimental low back pain. J Biomech 2020; 112:110053. [PMID: 33035844 DOI: 10.1016/j.jbiomech.2020.110053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/06/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
Movement adaptations to low back pain (LBP) are believed to protect the painful area. Increased trunk stiffness and decreased trunk damping have been shown in people with recurrent LBP. However, no study has examined these properties using external force perturbations to the trunk during acute LBP when protective adaptations might be expected to have most relevance. Adaptations to an acute painful stimulus via unilateral injection of hypertonic saline into the right longissimus muscle were assessed using a trunk force perturbation paradigm and a mass-spring-damper model to describe effective trunk dynamical properties. Equal weights (15% body weight) were connected to the front and back of the trunk via a cable. Either one was dropped at random to perturb the trunk. Effective trunk dynamical properties were estimated in fourteen males (mean (standard deviation) age 25 (6) years) assuming that trunk movement can be modelled as a second order linear system. Effective trunk dynamical properties were compared before, during and after the experimentally induced painful period. Estimates of effective trunk stiffness (K) decreased and damping (B) increased during pain compared to both before ([mean contrast, 95% CI] K: -403 [-651 to -155] Nm-1, B: 28 [9-50] Nms-1) and after (K: -324 [-58 to -591] Nm-1, B: 20 [4-33] Nms-1) the experimentally induced painful period. We interpret our results to show that, when challenged by a step force perturbation, a healthy system adapts to noxious input by controlling trunk velocity rather than trunk displacement, in contrast to observations during remission from recurrent clinical LBP.
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Affiliation(s)
- Wolbert van den Hoorn
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, Australia.
| | - Jacek Cholewicki
- Center for Orthopedic Research, Department of Osteopathic Surgical Specialties, Michigan State University College of Osteopathic Medicine, MI, USA
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia; Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David M Klyne
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, Australia
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health and Rehabilitation Sciences, Australia
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