Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit

Optical Marker-Based Motion Capture of the Human Spine: A Scoping Review of Study Design and Outcomes

Biomechanical analysis of the human spine is crucial to understanding injury patterns. Motion capture technology has gained attention due to its non-invasive nature. Nevertheless, traditional motion capture studies consider the spine a single rigid segment, although its alignment changes during movement. Moreover, guidelines that indicate where markers should be placed for a specific exercise do not exist. This study aims to review the methods used to assess spine biomechanics using motion capture systems to determine the marker sets used, the protocols used, the resulting parameters, the analysed activities, and the characteristics of the studied populations. PRISMA guidelines were used to perform a Scoping Review using SCOPUS and Web of Science databases. Fifty-six journal and conference articles from 1997 to 2023 were considered for the analysis. This review showed that Plug-in-Gait is the most used marker set. The lumbar spine is the segment that generates the most interest because of its high mobility and function as a weight supporter. Furthermore, angular position and velocity are the most common outcomes when studying the spine. Walking, standing, and range of movement were the most studied activities compared to sports and work-related activities. Male and female participants were recruited similarly across all included articles. This review presents the motion capture techniques and measurement outcomes of biomechanical studies of the human spine, to help standardize the field. This work also discusses trends in marker sets, study outcomes, studied segments and segmentation approaches.

Differences in musculoskeletal dysfunctions and in postural alterations between chronic migraine and chronic tension type headache: A cross-sectional study

OBJECTIVE

The aim of present study is to assess postural alterations and musculoskeletal dysfunctions over all spine in patients with chronic migraine and chronic tension type headache, moreover to highlight the differences between these two forms of primary headache.

METHODS

A Cross sectional study was adopted to evaluate the musculoskeletal profile in patients with chronic migraine and with chronic tension type headache. The Bio photogrammetric evaluation was performed using the postural assessment software PAS/SAPO, while unilateral passive accessory intervertebral motion (PAIMs) were applied for manual examinations of spine segments from C0 to L5 vertebra. The One-way Analysis of Variance (ANOVA) test was used to compare the three groups with the software GraphPad InStat 3.06.

RESULTS

A total of 60 patients were recruited, 20 for chronic tension type group, 20 for chronic migraine group and 20 healthy controls. The most interesting findings was that patients with chronic primary headaches presented postural alterations in all parameters (cranio-vertebral angle and lumbar-pelvic angle) and musculoskeletal dysfunctions in all spine with respect to healthy controls. Finally, the most clinically relevant finding was that no differences were found between chronic migraine and chronic tension type headache concerning the postural alterations nor the musculoskeletal dysfunctions.

CONCLUSION

The sensitization acts as a substrate or consequence of these musculoskeletal dysfunctions in chronic primary headache. Therefore, non-pharmacological treatments targeted in the musculoskeletal system may be a good option in the management of chronic primary headache, especially when these therapies integrate various techniques that involve all spine.

Dynamic segmental kinematics of the lumbar spine during diagnostic movements

Background: In vivo measurements of segmental-level kinematics are a promising avenue for better understanding the relationship between pain and its underlying, multi-factorial basis. To date, the bulk of the reported segmental-level motion has been restricted to single plane motions. Methods: The present work implemented a novel marker set used with an optical motion capture system to non-invasively measure dynamic, 3D in vivo segmental kinematics of the lower spine in a laboratory setting. Lumbar spinal kinematics were measured for 28 subjects during 17 diagnostic movements. Results: Overall regional range of motion data and lumbar angular velocity measurement were consistent with previously published studies. Key findings from the work included measurement of differences in ascending versus descending segmental velocities during functional movements and observations of motion coupling paradigms in the lumbar spinal segments. Conclusion: The work contributes to the task of establishing a baseline of segmental lumbar movement patterns in an asymptomatic cohort, which serves as a necessary pre-requisite for identifying pathological and symptomatic deviations from the baseline.

The effect of low back pain on spine kinematics: A systematic review and meta-analysis

BACKGROUND

Although impairments in dorso-lumbar spine mobility have been previously reported in patients with low back pain, its exact mechanism is not yet clear. Therefore, the purpose of this systematic review and meta-analysis is to investigate and compare spinal kinematics between subjects with and without low back pain and identify appropriate tools to evaluate it.

METHODS

The PubMed, Scopus and Web of Science databases were searched for relevant literature. The search strategy was mainly focused on studies investigating lumbar kinematics in subjects with and without low back pain during clinical functional tests, gait, sports and daily functional activities. Papers were selected if at least one of these outputs was reported: lumbar range of motion, lumbar velocity, lumbar acceleration and deceleration, lordosis angle or lumbar excursion.

FINDINGS

Among 804 papers, 48 met the review eligibility criteria and 29 were eligible to perform a meta-analysis. Lumbar range of motion was the primary outcome measured. A statistically significant limitation of the lumbar mobility was found in low back pain group in all planes, and in the frontal and transverse planes for thoracic range of motion, but there is no significant limitation for pelvic mobility. The amount of limitation was found to be more important in the lumbar sagittal plane and during challenging functional activities in comparison with simple activities.

INTERPRETATION

The findings of this review provide insight into the impact of low back pain on spinal kinematics during specific movements, contributing to our understanding of this relationship and suggesting potential clinical implications.

Relationship between spinal imbalance and knee osteoarthritis by using full-body EOS

BACKGROUND

Orthostatic state is maintained by harmonizing the spine, pelvis and lower extremities. In the past few decades, several studies have demonstrated the associations between spinal imbalance and generalized osteoarthritis. The compensatory mechanisms of pelvis translation and knee flexion, however, have not been fully assessed.

METHODS

A total of 213 volunteers, over 40 years of age, were recruited. Radiological measurements were performed by EOS imaging system. Pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), sagittal vertical axis (SVA), global tilt (GT), hip-knee-angle (HKA), knee flexion angle (KFA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were measured. On the basis of SRS-Schwab, the subjects were classified into decompensated group (PI-LL > 20°), compensated group(10° ≤ PI-LL ≤ 20°), and normal group (PI-LL < 10°). Differences in radiographic parameters among groups were evaluated. Data of Knee Society Score (KSS) and Oswestry Disability Index (ODI) score were collected via questionnaires.

RESULTS

Decompensated group showed larger pelvic parameters (PT) and low extremity parameters (LDFA, MPTA, HKA and KFA) than normal group (P < 0.05). Pelvic parameter was larger in the compensated group (median = 31°) compared to the normal group (median = 17°) (P < 0.05). There was no difference in low extremity parameters between the compensated and normal groups. At the sagittal plane, the radiological parameters of spine were greater in subjects with patellofemoral joint pain (PFP) than without PFP (P = 0.058). Higher PI-LL values were observed in women (P < 0.05).

CONCLUSIONS

A correlation between sagittal spinal imbalance and knee joint angles was recognized. The progression of knee and low back pain was associated with the severity of sagittal spinal imbalance. Pelvic retroversion was considered to be the probable compensatory mechanism.

Compensatory biomechanics and spinal loading during dynamic maneuvers in patients with chronic low back pain

Purpose

This study explores the biomechanics underlying the sit-to-stand (STS) functional maneuver in chronic LBP patients to understand how different spinal disorders and levels of pain severity relate to unique compensatory biomechanical behaviors. This work stands to further our understanding of the relationship between spinal loading and symptoms in LBP patients.

Methods

We collected in-clinic motion data from 44 non-specific LBP (NS-LBP) and 42 spinal deformity LBP (SD-LBP) patients during routine clinical visits. An RGB-depth camera tracked 3D joint positions from the frontal view during unassisted, repeated STS maneuvers. Patient-reported outcomes (PROs) for back pain (VAS) and low back disability (ODI) were collected during the same clinical visit.

Results

Between patient groups, SD-LBP patients had 14.3% greater dynamic sagittal vertical alignment (dSVA) and 10.1% greater peak spine torque compared to NS-LBP patients (p < 0.001). SD-LBP patients also had 11.8% greater hip torque (p < 0.001) and 86.7% greater knee torque (p = 0.04) compared to NS-LBP patients. There were no significant differences between patient groups in regard to anterior or vertical torso velocities, but anterior and vertical torso velocities correlated with both VAS (r = − 0.38, p < 0.001) and ODI (r = − 0.29, p = 0.01). PROs did not correlate with other variables.

Conclusion

Patients with LBP differ in movement biomechanics during an STS transfer as severity of symptoms may relate to different compensatory strategies that affect spinal loading. Further research aims to establish relationships between movement and PROs and to inform targeted rehabilitation approaches.