The effect of lifting and lowering an external load on repositioning error of trunk flexion-extension in subjects with and without low back pain

The effects of proprioceptive weighting changes on posture control in patients with chronic low back pain: a cross-sectional study

Introduction

Patients with chronic low back pain (CLBP) exhibit changes in proprioceptive weighting and impaired postural control. This study aimed to investigate proprioceptive weighting changes in patients with CLBP and their influence on posture control.

Methods

Sixteen patients with CLBP and 16 healthy controls were recruited. All participants completed the joint reposition test sense (JRS) and threshold to detect passive motion test (TTDPM). The absolute errors (AE) of the reposition and perception angles were recorded. Proprioceptive postural control was tested by applying vibrations to the triceps surae or lumbar paravertebral muscles while standing on a stable or unstable force plate. Sway length and sway velocity along the anteroposterior (AP) and mediolateral (ML) directions were assessed. Relative proprioceptive weighting (RPW) was used to evaluate the proprioception reweighting ability. Higher values indicated increased reliance on calf proprioception.

Results

There was no significant difference in age, gender, and BMI between subjects with and without CLBP. The AE and motion perception angle in the CLBP group were significantly higher than those in the control group (JRS of 15°: 2.50 (2.50) vs. 1.50 (1.42), JRS of 35°: 3.83 (3.75) vs. 1.67 (2.00), p_JRS < 0.01; 1.92 (1.18) vs. 0.68 (0.52), p_TTDPM < 0.001). The CLBP group demonstrated a significantly higher RPW value than the healthy controls on an unstable surface (0.58 ± 0.21 vs. 0.41 ± 0.26, p < 0.05). Under the condition of triceps surae vibration, the sway length (p_stable < 0.05; p_unstable < 0.001), AP velocity (p_stable < 0.01; p_unstable < 0.001) and ML velocity (p_unstable < 0.05) had significant group main effects. Moreover, when the triceps surae vibrated under the unstable surface, the differences during vibration and post vibration in sway length and AP velocity between the groups were significantly higher in the CLBP group than in the healthy group (p < 0.05). However, under the condition of lumbar paravertebral muscle vibration, no significant group main effect was observed.

Conclusion

The patients with CLBP exhibited impaired dynamic postural control in response to disturbances, potentially linked to changes in proprioceptive weighting.

Intra-rater and inter-rater reliability of neutral and target lumbar positioning tests in subjects with and without non-specific lower back pain

BACKGROUND

Proprioception, one's sense of movement and position, is a common term used in back rehabilitation. Kinesthetic rehabilitation may be useful in managing lower back pain; however, reliable measures are required to quantify lumbar proprioception sense.

OBJECTIVE

To investigate intrarater and interrater reliability of neutral lumbar positioning (NLP) and target lumbar positioning (TLP) tests and compare the position sense errors in subjects with non-specific low back pain and healthy controls.

METHODS

Intrarater (between-day) and interrater (within-day) reliability of NLP and TLP tests were assessed in 30 subjects with low back pain and 30 healthy subjects using a digital inclinometer. NLP is evaluated when the subject is repositioned to neutral from flexion, while TLP is evaluated in lumbar flexion, by bending laterally left and right.

RESULTS

Intrarater reliability for NLP tests had ICC values of 0.85 and 0.89 and TLP tests had 0.78 and 0.92. Likewise, interrater reliability for NLP had ICC values of 0.75 and 0.85, and for the TLP test, the interrater reliability had 0.78 and 0.93. Subjects with back pain had significantly larger neutral and target lumbar proprioceptive errors compared to healthy controls (p< 0.001).

CONCLUSIONS

Intrarater and interrater reliability showed good agreement for both NLP and TLP tests of lumbar proprioception. Subjects with nonspecific low back pain have impaired lumbar proprioceptive sense.

Short-term effect of kinesiology taping on pain, functional disability and lumbar proprioception in individuals with nonspecific chronic low back pain: a double-blinded, randomized trial

Background

This study aimed to evaluate the effect of kinesiology taping (KT) on lumbar proprioception, pain, and functional disability in individuals with nonspecific chronic low back pain (CLBP).

Methods

Thirty individuals with nonspecific CLBP participated in this double-blinded, randomized clinical trial from July 2017 to September 2018. The participants were randomized into two groups: KT (n = 15) and placebo group (n = 15). KT was applied with 15–25% tension for 72 h, and placebo taping was used without tension. Lumbar repositioning error was measured by a bubble inclinometer at three different angles (45° and 60° flexion, and 15° extension) in upright standing. Pain and disability were assessed by the Short-Form McGill Pain Questionnaire and Oswestry Disability Index, respectively. All measurements were recorded at baseline and 3 days after taping.

Results

Pain and disability scores reduced 3 days after taping in the KT group with large effect sizes (p < 0.05). Only the total score of pain was significantly different between the groups 3 days after taping and improved more in the KT group with a large effect size (p < 0.05). However, lumbar repositioning errors were similar between the groups after 3 days (p > 0.05). Also, only constant error of 15° extension showed a moderate correlation with disability (r = 0.39, p = 0.02).

Conclusion

KT can decrease pain and disability scores after 3 days of application. Although placebo taping can reduce pain, the effect of KT is higher than placebo taping. The findings do not support the therapeutic effect of KT and placebo taping as a tool to enhance lumbar proprioception in patients with nonspecific CLBP.

Trial registration

The study prospectively registered on 21.05.2018 at the Iranian Registry of Clinical Trials: IRCT20090301001722N20.

Balance Control in Patients with Subacute Non-Specific Low Back Pain, with and without Lumbar Instability: A Cross-Sectional Study

Background

Patients with low back pain (LBP) have poorly coordinated neuromuscular control, which may alter the normal postural stability of the spine. Altered movement control may occur at any stage of LBP.

Purpose

(1) To identify differences in balance control and proprioceptive sense between subacute non-specific LBP (NSLBP) patients with and without lumbar instability (LI) and healthy subjects and (2) to investigate the correlation between factors of motor control deficits and balance.

Patients and Methods

Thirty-six participants matched by gender, age, and body mass index (BMI) were allocated into three groups of 12: subacute NSLBP patients with LI, subacute NSLBP patients without LI, and healthy subjects. Balance, proprioceptive sense, pain, functional disability, and fear of movement were evaluated.

Results

Subacute NSLBP patients with LI exhibited greater impairments in balance control, proprioceptive sense, and functional ability than patients without LI (p<0.05). Subacute NSLBP patients showed more impairments in balance control, proprioceptive sense, and fear of movement than healthy subjects (p<0.001), with the following effect sizes (partial η²) for static balance on stable and unstable surface: 0.597 and 0.560, anticipatory balance: 0.417, and dynamic balance: 0.536; proprioceptive sense: 0.676; and fear of movement: 0.379. Significant fair correlations were found between (1) static balance and proprioceptive sense, functional disability, and fear of movement; (2) functional reach test (FRT) and pain; and (3) the five times sit to stand test (FTSTS) and functional disability.

Conclusion

Subacute NSLBP patients with LI showed greater impairment in balance control than patients without LI. Reduced proprioceptive sense, increased pain, functional disability, and fear of movement were fairly related to impaired balance.

Are there differences in lifting technique between those with and without low back pain? A systematic review

Background and aims

To systemically review the literature to compare freestyle lifting technique, by muscle activity and kinematics, between people with and without low back pain (LBP).

Methods

Five databases were searched along with manual searches of retrieved articles by a single reviewer. Studies were included if they compared a freestyle lifting activity between participants with and without LBP. Data were extracted by two reviewers, and studies were appraised using the CASP tool for case-control studies.

Results

Nine studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n = 8 studies) reported that people with LBP lift differently to pain-free controls. Specifically, people with LBP lift more slowly (n = 6 studies), use their legs more than their back especially when initiating lifting (n = 3 studies), and jerk less during lifting (n = 1 studies). Furthermore, the four larger studies involving people with more severe LBP also showed that people with LBP lift with less spinal range of motion and greater trunk muscle activity for a longer period.

Conclusions

People with LBP move slower, stiffer, and with a deeper knee bend than pain-free people during freestyle lifting tasks. Interestingly, such a lifting style mirrors how people, with and without LBP, are often told how to lift during manual handling training. The cross-sectional nature of the comparisons does not allow for causation to be determined.

Implications

The changes described may show embodiment of cautious movement, and the drive to protect the back. There may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.

Is There a Relationship Between Lumbar Proprioception and Low Back Pain? A Systematic Review With Meta-Analysis

OBJECTIVE

To systematically review the relationship between lumbar proprioception and low back pain (LBP).

DATA SOURCES

Four electronic databases (PubMed, EMBASE, CINAHL, SPORTDiscus) and reference lists of relevant articles were searched from inception to March-April 2014.

STUDY SELECTION

Studies compared lumbar proprioception in patients with LBP with controls or prospectively evaluated the relationship between proprioception and LBP. Two reviewers independently screened articles and determined inclusion through consensus.

DATA EXTRACTION

Data extraction and methodologic quality assessment were independently performed using standardized checklists.

DATA SYNTHESIS

Twenty-two studies (1203 participants) were included. Studies measured lumbar proprioception via active or passive joint repositioning sense (JRS) or threshold to detection of passive motion (TTDPM). Data from 17 studies were pooled for meta-analyses to compare patients with controls. Otherwise, descriptive syntheses were performed. Data were analyzed according to measurement method and LBP subgroup. Active JRS was worse in patients compared with controls when measured in sitting (standard mean difference, .97; 95% confidence interval [CI], .31-1.64). There were no differences between groups measured via active JRS in standing (standard mean difference, .41; 95% CI, -.07 to .89) or passive JRS in sitting (standard mean difference, .38; 95% CI, -.83 to 1.58). Patients in the O'Sullivan flexion impairment subgroup had worse proprioception than the total LBP cohort. The TTDPM was significantly worse in patients than controls. One prospective study found no link between lumbar proprioception and LBP.

CONCLUSIONS

Patients with LBP have impaired lumbar proprioception compared with controls when measured actively in sitting positions (particularly those in the O'Sullivan flexion impairment subgroup) or via TTDPM. Clinicians should consider the relationship between sitting and proprioception in LBP and subgroup patients to guide management. Further studies focusing on subgroups, longitudinal assessment, and improving proprioception measurement are needed.

Evaluation of the ShapeTape for studying biomechanics in the workplace

Motion capture systems may be difficult to use in harsh environments such as a poultry plant, and therefore should be self-contained, portable, unobtrusive, and not interfere with or be degraded by plant machinery or processes. The purpose of this study was to evaluate the validity, reliability and accuracy of the ShapeTape system as a potential solution. This was accomplished by comparing kinematic data from the ShapeTape against the Vicon system. Subjects performed cyclical movements along a plane angled 45° up from the horizontal using their right arms. Results revealed that the ShapeTape kinematic data was significantly larger than the Vicon data, yet statistically reliable.

Low back pain history and postural sway in unstable sitting

STUDY DESIGN

A cross-sectional study comparing subjects with self-reported low back pain, recent low back, and no low back pain.

OBJECTIVE

To determine differences in trunk postural control between groups.

SUMMARY OF BACKGROUND DATA

Poor postural control has been demonstrated in patients with low back pain, but the cause of this is unknown.

METHODS

A total of 331 participants of a longitudinal study participated in a seated balancing task. Based on a questionnaire, subjects were subdivided in 3 groups: current-LBP, recent-LBP (last 12 months), no-LBP. Subjects balanced on a seat mounted over a hemisphere during three 30-second trials. Sway amplitudes (RMS), mean power frequency (MPF), short-term diffusion coefficients (DS), and critical point (CP) coordinates of sway were calculated.

RESULTS

RMS values differed significantly between groups, with smaller values in recent-LBP than in no-LBP. MPF values were lowest in current-LBP. DS values were highest in no-LBP, with significant differences between this group and recent-LBP only. CP values were generally lower for recent-LBP than both other groups.

CONCLUSION

In contrast with previous findings, postural sway amplitudes in unstable sitting were not different between LBP and healthy subjects, while subjects with a recent history of LBP showed smaller amplitudes. Higher DS values in subjects without LBP indicated more stochastic sway. These findings may be explained by the disturbing effect of current pain on postural control causing low sway frequencies and by lower effort in balancing in healthy subjects causing high sway amplitudes and diffusion coefficients.