Trunk and pelvic coordination at various walking speeds during an anterior load carriage task in subjects with and without chronic low back pain

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.

The Effect of Core Stabilization Exercises on Trunk-Pelvis Three-Dimensional Kinematics During Gait in Non-Specific Chronic Low Back Pain

STUDY DESIGN

Controlled clinical trial study.

OBJECTIVE

This study aimed to evaluate the effect of core stabilization exercise program (CSEP) on trunk-pelvis kinematics during gait in non-specific chronic low back pain (NCLBP).

SUMMARY OF BACKGROUND DATA

NCLBP is a major public burden with variety of dysfunction including gait variability.

METHODS

Thirty participants (15 NCLBP and 15 healthy) were included in this study via the convenience sampling method. NCLBP group were intervened via the 16 sessions CSEP 3 days for 6 weeks and trunk-pelvis kinematics (angular displacement, waveform pattern [CVp], and offset variability [CVo]) during gait, pain, disability were evaluated before and after the intervention.

RESULTS

No significant differences in displacement and CVo in three planes were found between NCLBP and healthy groups. Independent t test was revealed that significant differences in CVp in the sagittal, frontal, and transverse planes were found between healthy and NCLBP in pre intervention. No significant changes in displacement and CVo were found as the result of intervention in NCLBP. Pain and disability decreased significantly after intervention. Paired t test revealed that the CSEP increased the frontal (P = 0.04) and transverse planes (P = 0.02) pattern variability significantly. However, there was a significant difference between groups in the sagittal plane CVp after intervention (sagittal plane CVp in healthy vs. NCLBP in post-CSE: mean difference = 14.1; P = 0.04).

CONCLUSION

Considering the role of the deep trunk muscles in gait, and their common deconditioning in CLBP, a CSEP intervention may increase trunk-pelvis kinematic pattern variability. These results suggest CSEP may specifically increase transverse and frontal plane variability, indicating improved motor pattern replication through this movement planes.

LEVEL OF EVIDENCE

2.

Gender-Related Differences in Reliability of Thorax, Lumbar, and Pelvis Kinematics During Gait in Patients With Non-specific Chronic Low Back Pain

Objective

To evaluate test-retest reliability of trunk kinematics relative to the pelvis during gait in two groups (males and females) of patients with non-specific chronic low back pain (NCLBP) using three-dimensional motion capture system.

Methods

A convenience sample of 40 NCLBP participants (20 males and 20 females) was evaluated in two sessions. Participants were asked to walk with self-selected speed and kinematics of thorax and lumbar spine were captured using a 6-infrared-cameras motion-analyzer system. Peak amplitude of displacement and its measurement errors and minimal detectable change (MDC) were then calculated.

Results

Intraclass correlation coefficients (ICCs) were relatively constant but small for certain variables (lower lumbar peak flexion in female: inter-session ICC=0.51 and intra-session ICC=0.68; peak extension in male: inter-session ICC=0.67 and intra-session ICC=0.66). The measurement error remained constant and standard error of measurement (SEM) difference was large between males (generally ≤4.8°) and females (generally ≤5.3°). Standard deviation (SD) was higher in females. In most segments, females exhibited higher MDCs except for lower lumbar sagittal movements.

Conclusion

Although ICCs were sufficiently reliable and constant in both genders during gait, there was difference in SEM due to difference in SD between genders caused by different gait disturbance in chronic low back pain. Due to the increasing tendency of measurement error in other areas of men and women, attention is needed when measuring lumbar motion using the method described in this study.

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.

Effect of an on-hip load-carrying belt on physiological and perceptual responses during bimanual anterior load carriage

Manual load carriage continues to be a major contributor of musculoskeletal injury. This study investigates the physiological and subjective effects of an on-hip load-carrying belt (HLCB) during bimanual anterior load carriage. Fifteen healthy male participants walked on a level ground treadmill at 4.5 km/h for 5 min carrying 5, 10 and 15 kg loads with hands and arms in front of the body, with and without using the HLCB (WD and ND). Heart rate, normalized oxygen uptake, minute ventilation and, central and peripheral ratings of perceived exertion were the dependent variables. The mean heart rate, normalized oxygen uptake, minute ventilation and peripheral rating of perceived exertion increased significantly with load under both WD and ND conditions. At a load of 15 kg, the mean heart rate, normalized oxygen uptake, minute ventilation and peripheral rating of perceived exertion were significantly lower by 6.6%, 8.0%, 11.8% and 13.9% respectively in WD condition when compared to the ND condition. There was no significant difference between WD and ND conditions with 5 or 10 kg load. It can be concluded that the HLCB could reduce a person's physiological and peripheral perceptual responses when walking on a level ground treadmill at 4.5 km/h with a load of 15 kg. Using a HLCB or similar device is therefore recommended for bimanual anterior load carriage for loads of 15 kg or probably larger.