Analysis of 3D multi-segment lumbar spine motion during gait and prone hip extension

Characteristics, Relationships, and Differences in Muscle Activity and Impact Load Attenuation During Tennis Forehand Stroke with Different Grips

In forehand strokes with different grips in tennis, the forearm muscle activities, the distribution and attenuation of the impact loads, and the effects of the muscles on the impact load attenuation exhibited different characteristics. This study aimed to explore these characteristics by analyzing electromyography (EMG) and acceleration data, and comparing the differences between the Eastern and Western grips. Fourteen level II or above tennis players (ten males, aged 22.4 ± 3.6 years; four females, aged 19.8 ± 2.0 years) were recruited and instructed to perform forehand strokes using the Eastern and Western grips, respectively. The EMG of eight forearm muscles and the acceleration data at the ulnar and radial sides of the wrist and elbow were collected. The root mean square (RMS), the peaks of the impact load, the amplitude of impact load attenuation (AC), and the jerk value (Jerk) were calculated. The cross-correlation coefficients and time delays of EMG-EMG, EMG-AC, and EMG-jerk were obtained using the cross-correlation method. The results showed that in the Eastern grip group (group E), the RMS of the flexor carpi ulnaris (FCU) was significantly greater than that in the Western grip group (group W). In group E, the peaks of impact load, AC, and Jerk on the Y axis of the wrist ulnar side were all significantly higher than those in group W. The activity of the extensor digitorum commonis (EDC) had significantly different effects on the amplitude and rate of impact load attenuation at specific locations in different grips, especially at the elbow (p < 0.05). The conclusion indicated that the FCU exhibited higher levels of EMG activity in the Eastern grip. This grip responded to greater impact loads with more substantial and rapid attenuation on the wrist ulnar side. Furthermore, the EDC appeared to contribute more to the amplitude of impact load attenuation in the Western grip and to have a more significant influence on the rate of impact load attenuation in the Eastern grip, especially at the elbow. These results suggest that tennis players and coaches should pay more attention to improving the strength of the EDC and FCU, which can improve sports performance and comfort, as well as prevent sports injuries.

The clinical utility of the prone hip extension test in the diagnosis of motor control impairments associated with low back pain: A cross-sectional study using motion capture and electromyography

BACKGROUND

The prone hip extension test is used as a clinical tool to diagnose specific motor control impairments that have been identified in individuals with chronic low back pain. However, conventional protocols for performing the test are subjective and lack evidence for their effectiveness. The objective of the current study was to quantify lumbopelvic motion and muscle activation during this test and identify which motor control patterns best distinguish individuals with low back pain from asymptomatic controls.

METHODS

18 individuals with sub-acute or chronic low back pain and 32 asymptomatic controls performed the prone hip extension test while a 3D motion capture system measured lumbar and pelvic movement patterns and an electromyography system measured the muscle activation patterns of the paraspinal, gluteus maximus, and hamstring muscles. A three-stage statistical analysis was performed, the final stage being a stepwise logistic regression analysis aimed at identifying the movement and muscle activation pattern variables that best distinguished the two groups.

FINDINGS

The final regression model included three lumbar kinematic variables and several electromyographic amplitude variables for the gluteus maximus and hamstring muscles during right-sided prone hip extension. The final model correctly classified 86.7 % of the control group and 83.3 % of the low back pain group.

INTERPRETATION

The subject of asymmetrical gluteus maximus and hamstring muscle activation appears to be a potentially interesting area for future research on the utility of the prone hip extension test as a clinical tool in diagnosing motor control impairments associated with low back pain.

Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review

BACKGROUND

Spine disorders are becoming more prevalent in today's ageing society. Motion abnormalities have been linked to the prevalence and recurrence of these disorders. Various protocols exist to measure thoracolumbar spine motion, but a standard multi-segmental approach is still missing. This study aims to systematically evaluate the literature on stereophotogrammetric motion analysis approaches to quantify thoracolumbar spine kinematics in terms of measurement reliability, suitability of protocols for clinical application and clinical significance of the resulting functional assessment.

METHODS

Electronic databases (PubMed, Scopus and ScienceDirect) were searched until February 2022. Studies published in English, investigating the intersegmental kinematics of the thoracolumbar spine using stereophotogrammetric motion analysis were identified. All information relating to measurement reliability; measurement suitability and clinical significance was extracted from the studies identified.

RESULTS

Seventy-four studies met the inclusion criteria. 33% of the studies reported on the repeatability of their measurement. In terms of suitability, only 35% of protocols were deemed suitable for clinical application. The spinous processes of C7, T3, T6, T12, L1, L3 and L5 were the most widely used landmarks. The spine segment definitions were, however, found to be inconsistent among studies. Activities of daily living were the main tasks performed. Comparable results between protocols are however still missing.

CONCLUSION

The literature to date offers various stereophotogrammetric protocols to quantify the multi-segmental motion of the thoracolumbar spine, without a standard guideline being followed. From a clinical point of view, the approaches are still limited. Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance.

Early dynamic changes within the spine following posterior fusion using hybrid instrumentation in adolescents with idiopathic scoliosis: a gait analysis study

INTRODUCTION

In adolescent idiopathic scoliosis (AIS) patients, mechanical consequences of posterior spinal fusion within the spine remain unclear. Through dynamic assessment, gait analysis could help elucidating this particular point. The aim of this study was to describe early changes within the spine following fusion with hybrid instrumentation in adolescents with idiopathic scoliosis, using gait analysis MATERIALS AND METHODS: We conducted a single-centre prospective study including AIS patients scheduled for posterior spinal fusion (PSF) using hybrid instrumentation with sublaminar bands. Patients underwent radiographic and gait analyses preoperatively and during early postoperative period. Among gait parameters, motion of cervicothoracic, thoracolumbar and lumbosacral junctions was measured in the three planes.

RESULTS

We included 55 patients (mean age 15 years, 84% girls). Fusion was performed on 12 levels and mean follow-up was 8 months. There was a moderately strong correlation between thoracolumbar sagittal motion and lumbosacral junction pre- and postoperatively (R = - 0.6413 and R = - 0.7040, respectively, all p < 0.001), meaning that the more thoracolumbar junction was in extension, the more lumbosacral extension movements decreased. There was a trend to significance between postoperative SVA change and thoracolumbar sagittal motion change (R = - 0.2550, p = 0.059).

DISCUSSION

This is the first series reporting dynamic changes within the spine following PSF using hybrid instrumentation in AIS patients. PSF led to symmetrization of gait pattern. In the sagittal plane, we found that thoracolumbar extension within the fused area led to decreased extension at cervicothoracic and lumbosacral junctions. Even though consequences of such phenomenon are unclear, attention must be paid not to give a too posterior alignment when performing PSF for AIS patients.

The deer play in Wuqinxi and four-point hand−knee kneeling positions for training core muscle function and spinal mobility

The four-point kneeling exercise is a core stabilization exercise that provides the spine with dynamic stability and neuromuscular control. In the traditional Chinese exercise Wuqinxi, deer play is performed in a hand−foot kneeling (HFK) position, which is remarkably similar to the four-point hand−knee kneeling (HKK) position. However, the differences in spinal function promotion between these two positions are poorly understood. The aim of this study was to investigate muscle activation patterns and spinal kinematics during specific core stabilization training to provide evidence for selecting specific exercises. A total of 19 healthy adults were recruited to perform HFK and HKK. The rotation angle of the C7–T4 vertebra and the surface EMG signals of abdominal and lumbar muscles on both sides were collected. The paired t-test showed that the vertebral rotation angles were significantly higher during HKK than HFK, and the intra-group differences mainly occurred at the level of the thoracic vertebra. The muscle activation of both sides of the rectus abdominis and external oblique in HFK was significantly higher than in HKK when the upper limb was lifted (p < 0.05). The activation of the ipsilateral lumbar multifidus and erector spinae muscles was significantly higher during the HKK position than during HFK when the lower limb was lifted (p < 0.05). HFK provided more training for strengthening abdominal muscles, while HKK could be recommended for strengthening lumbar muscles and increasing spine mobility. These findings can be used to help physiotherapists, fitness coaches, and others to select specific core exercises and develop individualized training programs.

Control of structural redundancy from the head to trunk in the human upright standing revealed using a data-driven approach

The human being dynamically and highly controls the head-trunk with redundant mechanical structures to maintain a stable upright standing position that is inherently unstable. The posture control strategies are also affected by the differences in the conditions of sensory inputs. However, it is unclear how the head-trunk segmental properties are altered to respond to situations that require appropriate changes in standing posture control strategies. We used a data-driven approach to conduct a multipoint measurement of head-trunk sway control in a quiet standing position with differences in the conditions of sensory inputs. Healthy young subjects with 22 accelerometers attached to their backs were evaluated for head-trunk vibration during quiet standing under two conditions: one with open eyes and one with closed eyes. The synchronization of the acceleration and the instantaneous phase was then calculated. The results showed that the synchronization of acceleration and instantaneous phase varied depending on the visual condition, and there were some continuous coherent patterns in each condition. Findings were that the structural redundancy of the head-trunk, which is multi-segmental and has a high mass ratio in the whole body, must be adjusted adaptively according to the conditions to stabilize upright standing in human-specific bipeds.

Motion of the multi-segmented spine in elite dancers during passé and arabesque

BACKGROUND

The spinal biomechanics of dance tasks have received little study and no studies have used a multi-segmented spinal model. Knowledge of how the segments of the spine move may be useful to the dance clinician and dance educator.

RESEARCH QUESTION

What is the direction and amount of motion of the primary segments of the spine in elite dancers during an arabesque and a passé?

METHODS

This observational study examined 59 elite dancers performing an arabesque and a passé using a three-dimensional motion analysis system with the trunk divided into a series of five segments: pelvis, lower lumbar, upper lumbar, lower thoracic and upper thoracic spine.

RESULTS

For the arabesque, all spinal segments moved in the same direction within each plane and the majority of total spinal motion occurred in the thoracic spine. Thoracic segments were at or near end range position at completion of the arabesque. For the passé, the spinal segments moved in different directions within each plane and the majority of total spinal motion occurred in the lumbar spine.

SIGNIFICANCE

Dance clinicians and dance educators may benefit from the knowledge that thoracic hypomobility in any plane may limit arabesque performance and that attempts to instruct dancers to achieve a position of passé without flexion of the lumbar spine may be a valid aesthetic ideal but also an unrealistic functional expectation.

Differences in multi-segmental spine kinematics between patients with different stages of axial spondyloarthritis and healthy controls

BACKGROUND

The effects of inflammation and ankylosis on spinal kinematics of patients with axial spondyloarthritis (axSpA) are poorly understood. Furthermore, existence of (mal)adaptive movement profiles within axSpA, and differences between movement profiles in sensation of pain or fear of movement has never been investigated.

OBJECTIVES

To investigate differences in range of motion in six spinal regions and the hips between inflammatory and ankylosed patients with axSpA, and to increase insight in different movement profiles of patients with axSpA and their association with pain and fear.

DESIGN

Observational, cross-sectional.

METHODS

Three-dimensional motion analysis was performed in 20 patients with axSpA and 23 healthy controls during range of motion tasks in all three planes. We compared patients with inflammatory (n = 8) and ankylosed (n = 12) axSpA, and controls. Patients were also classified into Flexion or Lordotic profile. Questionnaires regarding pain and fear of movement were conducted.

RESULTS/FINDINGS

Both inflammatory and ankylosed axSpA patients have limited spinal ROM and reduced movement speed compared to healthy controls. Patients with a Lordotic profile showed significantly less ROM in lumbar regions and experienced more pain during forward bending than patients with a Flexion profile.

CONCLUSIONS

Both inflammation and ankylosis contribute to spinal mobility impairment, and axSpA patients with a lordotic profile experienced more pain. This profile may be a maladaptive movement strategy to prevent further pain increase. Suggesting that pain and fear of movement, might be better variables to specify patients' spinal mobility limitations for individual physical therapy and rehabilitation patient profiling.

Characterization of trunk motion in adolescents with right thoracic idiopathic scoliosis

BACKGROUND

Although standard radiography is currently used for deformity assessment in AIS patients, it is performed in a constrained position and probably not reflective of spinal balance during daily-life activities. Our main objective was to compare trunk motion in Lenke 1 and 2 AIS patients to healthy volunteers, using gait analysis.

MATERIAL AND METHODS

Lenke 1 or 2 AIS patients planned for surgery were included. The day before surgery, they underwent radiographic evaluation and gait analysis. Among the gait parameters, sagittal vertical axis (Dyn-SVA), shoulder line rotation (Dyn-SL rotation), pelvis rotation (Dyn-P rotation) and acromion pelvis angle (Dyn-APA) were measured. AIS patients were compared to 25 asymptomatic controls.

RESULTS

A total of 57 patients were included in the study, with a mean Cobb angle of 55.4°. AIS patients had a lower Dyn-SVA when compared to controls (47.0 vs. 62.9 mm, p = 0.012). Dyn-APA and Dyn-SL rotation were negative in AIS patients, meaning that shoulder line was rotated towards the left (- 6.4 vs. 7.8° and - 7.5 vs. - 0.4°, p<0.001, respectively). On the other hand, Dyn-P rotation was positive, meaning that pelvis was rotated towards the right side during gait (1.1 vs. - 0.5, p = 0.026).

DISCUSSION

This is one of the largest series of gait analysis in AIS patients. We demonstrated that AIS patients have an abnormal gait pattern, with a decreased anterior tilt of the trunk and transverse plane abnormalities. We found that gait deviation was not related to radiographic measurements, pointing out that dynamic assessment provides new data about spinal posture. These slides can be retrieved under Electronic Supplementary Material.

Spinal segments do not move together predictably during daily activities

BACKGROUND

Considering the thoracic, lumbar spine or whole spine as rigid segments has been the norm until recent studies highlighted the importance of more detailed modelling. A better understanding of the requirement for spine multi-segmental analysis could guide planning of future studies and avoid missing clinically-relevant information.

RESEARCH QUESTION

This study aims to assess the correlation between adjacent spine segments movement thereby evaluating segmental redundancy in both healthy and participants with low back pain (LBP).

METHODS

A 3D motion capture system tracked the movement of upper and lower thoracic and lumbar spine segments in twenty healthy and twenty participants with LBP. Tasks performed included walking, sit-to-stand and lifting, repeated 3 times. 3D angular kinematics were calculated for each spine segment. Segmental redundancy was evaluated through cross-correlation (R_xy) analysis of kinematics time series and correlation of range of motion (R_ROM) of adjacent spine segments.

RESULTS

The upper/lower lumbar pairing showed weak correlations in the LBP group for all tasks and anatomical planes (R_xyrange:0.02-0.36) but moderate and strong correlations during walking (R_xy _frontalplane:0.4) and lifting (R_xy _sagittalplane:0.64) in the healthy group. The lower thoracic/upper lumbar pairing had weak correlations for both groups during lifting and sit-to-stand in the frontal plane and for walking (R_xy:0.01) in the sagittal plane only. The upper/lower thoracic pairing had moderate correlations during sit-to-stand in sagittal and transverse plane in patients with LBP (R_xy _sagittalplane:0.41; R_xy _transverse plane:-0.42) but weak in healthy (R_xy _sagittalplane:0.23; R_xy _transverseplane:-0.34); the contrary was observed during lifting. The majority of R_ROM values (55/72) demonstrated weak correlations.

SIGNIFICANCE

The results suggest that multi-segmental analysis of the spine is necessary if spine movement characteristics are to be fully understood. We cannot establish a priori where redundancy occurs based on healthy data, therefore extra consideration should be made when planning studies with pathological cohorts.

Immediate effect of application of the pressure technique to the psoas major on lumbar lordosis

[Purpose] To demonstrate immediate alteration in lumbar lordosis and the lumbar angle in each segment after the application of the mechanical pressure technique to the psoas major muscle (PM). [Participants and Methods] In all, 34 participants were assigned to either the PM pressure technique group (n=17) or control group (n=17). Three dimensional (3D) coordinates of the 12th thoracic spinous process and lumbar spinous processes were measured with a 3D digitizer in the prone position with 15° bilateral hip extension to compare the changes in lumbar lordosis and the lumbar extension angle in each segment in both the PM pressure technique group and control group. [Results] Mann-Whitney’s U test revealed no significant differences in lumbar lordosis in either group. However, the lumbar extension angle at L4 decreased significantly after the PM pressure technique compared with that before the pressure technique. Additionally, the lumbar extension angle at L4 also decreased significantly after the PM pressure technique compared with the control group. Conversely, lumbar extension angle at L1 increased significantly after the PM pressure technique compared with that before. There was no significant difference in the lumbar extension angle at L2, L3 and L5 after the PM pressure technique. [Conclusion] This study suggests that the PM pressure technique possibly attenuates PM stiffness while reducing lumbar extension in each segment.

A protocol for clinical trial study of the effect of core stabilization exercises on spine kinematics during gait with and without load in patients with non-specific chronic low back pain

Background

Non-specific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms such as gait abnormality. Trunk stiffness and deep trunk muscles dysfunction known as guarding mechanism in gait are factors leading to abnormal movement pattern of the spine. Anterior load carriage task during gait is also challenged the trunk stability and its movement pattern. It will be therefore of interest to examine the effect of a Core Stabilization Training Program (CSTP) on the trunk and pelvis kinematics including variability and peak displacement during gait with and without load in NCLBP patients.

Methods

Patients with NCLBP will participate in a program containing 16 sessions of CSTP and perceived pain, disability and kinematic will be evaluated with 100 mm visual analog scale (VAS), Oswestry Disability Index (ODI) and motion analyzing system respectively before and after the intervention. Participants will be asked to walk with self-selected comfortable speed for 3 times without load and 3 times with caring a load with hands.

Discussions

We will quantify the effectiveness of CSTP on the kinematic of trunk, lumbar and pelvis during gait. Comparing the kinematic pattern and movement variability using CV_o and CV_p can contribute to better understand the motor control strategy and movement pattern of the spine during an anterior load carriage task between patients with NCLBP and healthy.

Trial registration

IRCT number: IRCT2016080829264N1; pre-result.

The effects of bending speed on the lumbo-pelvic kinematics and movement pattern during forward bending in people with and without low back pain

BACKGROUND

Impaired lumbo-pelvic movement in people with low back pain during bending task has been reported previously. However, the regional mobility and the pattern of the lumbo-pelvic movement were found to vary across studies. The inconsistency of the findings may partly be related to variations in the speed at which the task was executed. This study examined the effects of bending speeds on the kinematics and the coordination lumbo-pelvic movement during forward bending, and to compare the performance of individuals with and without low back pain.

METHODS

The angular displacement, velocity and acceleration of the lumbo-pelvic movement during the repeated forward bending executed at five selected speeds were acquired using the three dimensional motion tracking system in seventeen males with low back pain and eighteen males who were asymptomatic. The regional kinematics and the degree of coordination of the lumbo-pelvic movement during bending was compared and analysed between two groups.

RESULTS

Significantly compromised performance in velocity and acceleration of the lumbar spine and hip joint during bending task at various speed levels was shown in back pain group (p < 0.01). Both groups displayed a high degree of coordination of the lumbo-pelvic displacement during forward bending executed across the five levels of speed examined. Significant between-group difference was revealed in the coordination of the lumbo-pelvic velocity and acceleration (p < 0.01). Asymptomatic group moved with a progressively higher degree of lumbo-pelvic coordination for velocity and acceleration while the back pain group adopted a uniform lumbo-pelvic pattern across all the speed levels examined.

CONCLUSIONS

The present findings show that bending speed imposes different levels of demand on the kinematics and pattern of the lumbo-pelvic movement. The ability to regulate the lumbo-pelvic movement pattern during the bending task that executed at various speed levels was shown only in pain-free individuals but not in those with low back pain. Individuals with low back pain moved with a stereotyped strategy at their lumbar spine and hip joints. This specific aberrant lumbo-pelvic movement pattern may have a crucial role in the maintenance of the chronicity in back pain.