Influences of lumbar disc herniation on the kinematics in multi-segmental spine, pelvis, and lower extremities during five activities of daily living

Analysis of lumbar spine loading during walking in patients with chronic low back pain and healthy controls: An OpenSim-Based study

Low back pain (LBP) is one of the most prevalent and disabling disease worldwide. However, the specific biomechanical changes due to LBP are still controversial. The purpose of this study was to estimate the lumbar and lower limb kinematics, lumbar moments and loads, muscle forces and activation during walking in healthy adults and LBP. A total of 18 healthy controls and 19 patients with chronic LBP were tested for walking at a comfortable speed. The kinematic and dynamic data of the subjects were collected by 3D motion capture system and force plates respectively, and then the motion simulation was performed by OpenSim. The OpenSim musculoskeletal model was used to calculate lumbar, hip, knee and ankle joint angle variations, lumbar moments and loads, muscle forces and activation of eight major lumbar muscles. In our results, significant lower lumbar axial rotation angle, lumbar flexion/extension and axial rotation moments, as well as the muscle forces of the four muscles and muscle activation of two muscles were found in patients with LBP than those of the healthy controls (p < 0.05). This study may help providing theoretical support for the evaluation and rehabilitation treatment intervention of patients with LBP.

Multibody Models of the Thoracolumbar Spine: A Review on Applications, Limitations, and Challenges

Numerical models of the musculoskeletal system as investigative tools are an integral part of biomechanical and clinical research. While finite element modeling is primarily suitable for the examination of deformation states and internal stresses in flexible bodies, multibody modeling is based on the assumption of rigid bodies, that are connected via joints and flexible elements. This simplification allows the consideration of biomechanical systems from a holistic perspective and thus takes into account multiple influencing factors of mechanical loads. Being the source of major health issues worldwide, the human spine is subject to a variety of studies using these models to investigate and understand healthy and pathological biomechanics of the upper body. In this review, we summarize the current state-of-the-art literature on multibody models of the thoracolumbar spine and identify limitations and challenges related to current modeling approaches.

Computational lumbar spine models: A literature review

BACKGROUND

Computational spine models of various types have been employed to understand spine function, assess the risk that different activities pose to the spine, and evaluate techniques to prevent injury. The areas in which these models are applied has expanded greatly, potentially beyond the appropriate scope of each, given their capabilities. A comprehensive understanding of the components of these models provides insight into their current capabilities and limitations.

METHODS

The objective of this review was to provide a critical assessment of the different characteristics of model elements employed across the spectrum of lumbar spine modeling and in newer combined methodologies to help better evaluate existing studies and delineate areas for future research and refinement.

FINDINGS

A total of 155 studies met selection criteria and were included in this review. Most current studies use either highly detailed Finite Element models or simpler Musculoskeletal models driven with in vivo data. Many models feature significant geometric or loading simplifications that limit their realism and validity. Frequently, studies only create a single model and thus can't account for the impact of subject variability. The lack of model representation for certain subject cohorts leaves significant gaps in spine knowledge. Combining features from both types of modeling could result in more accurate and predictive models.

INTERPRETATION

Development of integrated models combining elements from different model types in a framework that enables the evaluation of larger populations of subjects could address existing voids and enable more realistic representation of the biomechanics of the lumbar spine.

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.

Relationship between lumbar spine motor control ability and perceptual awareness during prone hip extension movement in people with low back pain

PURPOSE

The purpose of this study was to clarify the differences in lumbar spine and hip joint motor control ability (MCA) in prone hip extension (PHE) between individuals with and without low back pain (LBP). It also aimed to determine the relationship between lumbar spine and hip joint MCA and lumbar perceptual awareness in individuals with LBP.

METHODS

In total, 78 university students (20 with LBP and 58 without) were included in the study. The MCA of the lumbar spine and hip joint in PHE and perceptual awareness were evaluated. The MCA of the lumbar spine and hip joint was measured using a wearable sensor. Subsequently, a comparison of the MCA of the lumbar spine and hip joints of the participants and the relationship between MCA and lumbar perceptual awareness were examined.

RESULTS

The MCA of the LBP group was higher than that of the non-LBP group in motion on the sagittal plane. In addition, perceptual awareness was negatively correlated with MCA in the sagittal plane in the lumbar spine.

CONCLUSION

People with LBP had higher lumbar spine and hip joint MCA than those without LBP. Perceptual awareness was associated with lumbar spine and hip joint MCA in people with LBP. J. Med. Invest. 69 : 38-44, February, 2022.

Correlation between motor behavior and age-related intervertebral disc degeneration in cynomolgus monkeys

Background

The motor behavior in patients with lumbar intervertebral disc degeneration (IDD) and animal models should be changed due to pain. However, there does not seem to be a strong correlation between IDD and motor behavior. Therefore, it is necessary to understand the correlation between motor behavior and age‐related IDD.

Methods

Twenty‐one healthy male cynomolgus monkeys (Macaca fascicularis) distributed across the age range were included in this study. The experimental animals were divided into two groups: caged group (n = 14) and free‐range group (n = 7). The data of IDD and motor behavior were obtained through magnetic resonance imaging (MRI) and PrimateScan Automatic Behavior Analysis System. More than 20 basic motor behaviors could be recorded and quantified, and then reclassified into 9 combined categories. We defined the sum of the duration of activity‐related combined categories as the total duration of activity in 3 hours. The activity zone of the cynomolgus monkeys in the cage could be divided into top and bottom zones. Analyze the correlation between motor behavior and IDD.

Results

Age was correlated with both Pfirrmann grades (r = .700; P < .001) and T2 values (r = −.369; P < .001). The T2 value in the caged group was 45.97 ± 8.35 ms, which was significantly lower than the 55.90 ± 8.73 ms in the free‐range group (P < .001). The mean T2 values were positively correlated with hanging duration (r = .548, P < .05), the total duration of activity (r = .496, P < .05), and top zone duration (r = .541, P < .05).

Conclusions

There is an interactional relationship between IDD and motor behavior. Motor behavior could be used as one of the diagnostic indicators of IDD. It could also be used to infer the presence or extent of IDD in animal models. Avoiding a sedentary lifestyle and engaging in exercise in daily life could alleviate IDD.

Effect of different seat heights on lumbar spine flexion during stand-to-sit motion

[Purpose] This study aimed to investigate the movement of the thorax, lumbar spine, and pelvis when healthy participants sit on a chair, and to identify the kinematic characteristics due to changes in the height of the seat. [Participants and Methods] Twenty healthy participants (14 males, 6 females; mean age, 29 ± 5 years) were recruited for this study. They performed stand-to-sit motion using one seat with a height of 100% that of the lower leg length (standard) and another with a height of 60% that of the lower leg length (lower). A three-dimensional motion analysis system and four force plates were used to analyze each joint angle. [Results] The mean lumbar spine flexion angle was significantly increased in the lower versus the standard seat. As a kinematic characteristic, the pelvis tilted posteriorly while the thorax tilted anteriorly, which increased the lumbar spine flexion angle. The pelvis was tilted posteriorly when the hip joint flexed about 60° regardless of the seat height. [Conclusion] The lumbar spine flexion angle increased in the lower seat stand-to-sit motion, which suggested an increase in the load on the lumbar spine. The lumbar spine flexion angle was influenced by the characteristic movements of the thorax and pelvis.

Clinical Measures of Pelvic Tilt in Physical Therapy

Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures.

LEVEL OF EVIDENCE

5.

Lumbar and thoracic kinematics during step-up: Comparison of three-dimensional angles between patients with chronic low back pain and asymptomatic individuals

While alterations in spinal kinematics have been repeatedly observed in patients with chronic low back pain (CLBP), their exact nature is still unknown. Specifically, there is a need for comprehensive assessments of multisegment spinal angles during daily-life activities. The purpose of this exploratory study was to characterize three-dimensional angles at the lower lumbar, upper lumbar, lower thoracic, and upper thoracic joints in CLBP patients and asymptomatic controls during stepping up with three different step heights. Spinal angles of 10 patients with nonspecific CLBP (six males; 38.7 ± 7.2 years old, 22.3 ± 1.6 kg/m² ) and 11 asymptomatic individuals (six males; 36.7 ± 5.4 years old, 22.9 ± 3.8 kg/m² ) were measured in a laboratory using a camera-based motion capture system. Seven out of the 12 angle curves had characteristic patterns, leading to the identification of 20 characteristic peaks. Comparing peak amplitudes between groups revealed statistically significantly smaller sagittal- and frontal-plane angles in the patient group at the upper lumbar joint with the two higher steps and at the lower lumbar joint with the higher step. Significantly reduced angles were also observed in sagittal plane at the upper thoracic joint with the two smaller steps. Moreover, a higher number of significant differences between groups was detected with the two higher steps than with the smallest step. In conclusion, this study showed the value of a comprehensive description of spinal angles during step-up tasks and provided insights into the alterations with CLBP. These preliminary results support prior research suggesting that CLBP rehabilitation should facilitate larger amplitudes of motion during functional activities.

An index to quantify deviations from normal trunk mobility: Clinical correlation and initial test of validity

BACKGROUND

In case of people suffering from chronic low back pain, specific movements of the hip, pelvis, and trunk are associated with pain. Comparing range of motion measurements for multiple planes and from different segments and lines in reference to those of healthy individuals seems interesting but present interpretations challenge in relation to important number of variables and correlation with clinical data.

METHODS

The proposed index is based on using principal component analysis to quantify differences in trunk mobility between patients with chronic low back pain and a control group. Kinematic data were recorded for the cervical and thoracic vertebrae, the lumbar spine, and the pelvic and scapular belts during repeated trials (hip flexion and extension, hip bending, and trunk twists). Angular motion values were calculated. Principal component analysis was used to convert 10 discrete variables (kinematical data) extracted from control data into 10 independent variables.

FINDINGS

The proposed index comprises the sum of the variables. Initial demonstration of its clinical utility and statistical tests of this index validity were revealed. It establishes correlations between the psychosocial impact of chronic low back pain, trunk mobility (as summarized by the index) and the positive effects of functional restoration program.

INTERPRETATION

This index let to assess the absolute potential benefits of rehabilitation in term of kinematic motion. Functional restoration program promotes the physical functioning of patients by increasing their range of motion. This index uses kinematic motion to assess the potential benefits of such rehabilitation program.