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Mean (SE) differences in 3D kinematics of the lower extremity, during a step-up functional task in subjects with and without low back pain. * indicates a statistically significant effect of group from post-hoc tests (P = .001)
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Background
Low back pain (LBP) affects more than one third of the population at any given time, and chronic LBP is responsible for increased medical costs, functional limitations and decreased quality of life. A clear etiology is often difficult to identify, but aberrant posture and movement are considered contributing factors to chronic LBP that a...
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This study aimed to investigate the differences in lumbopelvic-hip movement pattern between patients with lumbar rotation with flexion and people without low back pain (LBP). A total of 20 male patients with lumbar Flexion + Rotation, confirmed based on the movement system impairment model, and 15 men without a history of LBP were included in this...
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.
Resea...
Citations
... Segmental RoMs in different anatomical planes showed, in most cases, no significant differences between the two groups ( Fig. 1). While some studies found smaller trunk RoM among LBP patients (Laird et al., 2019;Marras et al., 2004), our findings, consistent with other research studies (Larivière et al., 2002(Larivière et al., , 2000Mitchell et al., 2017;Š arabon et al., 2021) did not found significant differences. This discrepancy can be partially attributed to variations in measurement devices and LBP patients being studied (Nolan et al., 2020). ...
... This motor behaviour may have been reflected in this study findings. Our findings are also in line with Mitchell et al. who observed increased lower limb movements, knee movements in particular, during a step-up task in people with CLBP when compared to healthy controls [37]. Interestingly, Mitchell et al. [37] found that during step-up movement-a task that is predominantly performed in a sagittal plane, people with CLBP demonstrated increased knee movements in the coronal plane (i.e., out of plane movement). ...
... Our findings are also in line with Mitchell et al. who observed increased lower limb movements, knee movements in particular, during a step-up task in people with CLBP when compared to healthy controls [37]. Interestingly, Mitchell et al. [37] found that during step-up movement-a task that is predominantly performed in a sagittal plane, people with CLBP demonstrated increased knee movements in the coronal plane (i.e., out of plane movement). Similarly, when compared to healthy controls, people with CLBP had the tendency to utilize more hip and knee movements, in reference to the ankle, during a deep squat task to achieve similar maximum squat depth as healthy controls [38]. ...
The ability of the lumbar extensor muscles to accurately control static and dynamic forces is important during daily activities such as lifting. Lumbar extensor force control is impaired in low-back pain patients and may therefore explain the variances in lifting kinematics. Thirty-three chronic low-back pain participants were instructed to lift weight using a self-selected technique. Participants also performed an isometric lumbar extension task where they increased and decreased their lumbar extensor force output to match a variable target force within 20–50% lumbar extensor maximal voluntary contraction. Lifting trunk and lower limb range of motion and angular velocity variables derived from phase plane analysis in all planes were calculated. Lumbar extensor force control was analyzed by calculating the Root-Mean-Square Error (RMSE) between the participants’ force and the target force during the increasing (RMSEA), decreasing (RMSED) force portions and for the overall force error (RMSET) of the test. The relationship between lifting kinematics and RMSE variables was analyzed using multiple linear regression. Knee angular velocity in the sagittal and coronal planes were positively associated with RMSEA (R2 = 0.10, β = 0.35, p = 0.046 and R2 = 0.21, β = 0.48, p = 0.004, respectively). Impaired lumbar extensor force control is associated with increased multiplanar knee movement velocity during lifting. The study findings suggest a potential relationship between lumbar and lower limb neuromuscular function in people with chronic low-back pain.
... Finally, given the lack of objective metrics to better support clinical decisionmaking in evaluating treatment effects, our study highlights the potential use of a standardized functional motion assessment to quantify low back impairment and serve as potential endpoints Protected by copyright. 20 and other comparable research studies, [46][47][48][49][50][51][52][53] where differences were observed between healthy controls and patients. However, in contrast to our results, Marras et al observed lower magnitudes in acceleration values across planes. ...
Introduction
Low back pain is a significant burden to society and the lack of reliable outcome measures, combined with a prevailing inability to quantify the biopsychosocial elements implicated in the disease, impedes clinical decision-making and distorts treatment efficacy. This paper aims to validate the utility of a biopsychosocial spine platform to provide standardized wearable sensor-derived functional motion assessments to assess spine function and differentiate between healthy controls and patients. Secondarily, we explored the correlation between these motion features and subjective biopsychosocial measures.
Methods
An observational study was conducted on healthy controls (n=50) and patients with low back pain (n=50) to validate platform utility. The platform was used to conduct functional assessments along with patient-reported outcome assessments to holistically document cohort differences. Our primary outcomes were motion features; and our secondary outcomes were biopsychosocial measures (pain, function, etc).
Results
Our results demonstrated statistically significant differences in motion features between healthy and patient cohorts across anatomical planes. Importantly, we found velocity and acceleration in the axial plane showed the largest difference, with healthy controls having 49.7% and 55.7% higher values, respectively, than patients. In addition, we found significant correlations between motion features and biopsychosocial measures for pain, physical function and social role only.
Conclusions
Our study validated the use of wearable sensor-derived functional motion metrics in differentiating healthy controls and patients. Collectively, this technology has the potential to facilitate holistic biopsychosocial evaluations to enhance spine care and improve patient outcomes.
Trial registration number
NCT05776771 .
... On average, there were more men than women, especially in the LBP group. The mean BMI of the participants was reported in 32 studies, 17 studies (Christe et al., 2016b;Christe et al., 2017;Christe et al., 2020;Freddolini et al., 2014;Kim et al., 2014;Marich et al., 2017;Matheve et al., 2019;Miyakoshi et al., 2010;Pourahmadi et al., 2018;Pourahmadi et al., 2020;Rum et al., 2021;Sheikhhoseini et al., 2018;Tak et al., 2020;Tsang et al., 2017;Van Hoof et al., 2012;Zafereo et al., 2016;Zamiri et al., 2017) reported a mean BMI in the normal category (18.5 Kg/m 2 ≤ BMI < 25 Kg/m 2 ) and 15 studies (Al-Eisa et al., 2006a;Al-Eisa et al., 2006b;Coyle et al., 2017;Gombatto et al., 2015;Gombatto et al., 2017;Haj et al., 2019;Hernandez et al., 2017;Hidalgo et al., 2012;Laird et al., 2018;Masharawi et al., 2020;Mitchell et al., 2017;Nagai et al., 2015;Sánchez-Zuriaga et al., 2011;Seraj et al., 2018;Shojaei et al., 2017) reported a BMI in the over-weight category (25 Kg/m 2 ≤ BMI < 30 Kg/m 2 ). ...
... For 33 studies (Gombatto et al., 2015;Rum et al., Lee et al., 2011b;Marich et al., 2020;Masharawi et al., 2020;Miyakoshi et al., 2010;Papi et al., 2020;Seraj et al., 2018;Simonet et al., 2020;Sung, 2013;Vaisy et al., 2015;Wong and Lee, 2004) subjects had chronic LBP, for 5 (Freddolini et al., 2014;Nagai et al., 2015;Shojaei et al., 2017;Shum et al., 2005;Shum et al., 2007) acute to subacute LBP, and 10 remaining articles did not specify the type of LBP. A total of 35 studies (Basler et al., 2008;Christe et al., 2016b;Christe et al., 2017;Christe et al., 2020;Coyle et al., 2017;Freddolini et al., 2014;Gombatto et al., 2015;Gombatto et al., 2017;Haj et al., 2019;Hernandez et al., 2017;Hidalgo et al., 2012;Kim et al., 2014;Laird et al., 2018;Marich et al., 2017;Marich et al., 2020;Masharawi et al., 2020;Matheve et al., 2019;Mazloumi et al., 2021;Mitchell et al., 2017;Nagai et al., 2015;Papi et al., 2020;Pourahmadi et al., 2018;Pourahmadi et al., 2020;Rum et al., 2021;Sheikhhoseini et al., 2018;Shum et al., 2005;Shum et al., 2007;Simonet et al., 2020;Tak et al., 2020;Tsang et al., 2017;Vaisy et al., reported on pain intensity, measured by either the Visual Analog Scale VAS (18 over 50) or the Numerical Pain Rating Scale NPRS (17 over 50). 13 remaining studies did not report on the pain intensity. ...
... Reported mean pain intensity using the VAS or NPRS scale was transferred to a measurement scale of 0 to 10, and it was found to range from 1.42 to 6. The functional capacities was reported in 33 studies (Basler et al., 2008;Christe et al., 2016b;Christe et al., 2017;Christe et al., 2020;Coyle et al., 2017;Freddolini et al., 2014;Gombatto et al., 2015;Gombatto et al., 2017;Haj et al., 2019;Hernandez et al., 2017;Kim et al., 2014;Laird et al., 2018;Lee et al., 2011b;Marich et al., 2017;Marich et al., 2020;Masharawi et al., 2020;Matheve et al., 2019;Mitchell et al., 2017;Nagai et al., 2015;Papi et al., 2020;Pourahmadi et al., 2018;Pourahmadi et al., 2020;Rum et al., 2021;Sánchez-Zuriaga et al., 2011;Sheikhhoseini et al., 2018;Shum et al., 2005;Shum et al., 2007;Simonet et al., 2020;Sung, 2013;Tsang et al., 2017;Vaisy et al., 2015;Wildenbeest et al., 2022;Wong and Lee, 2004); disability was measured using the Roland Morris Disability Questionnaire (RMDQ) or the Oswestry Disability Index (ODI); reported mean disability using (ODI) ranged from 1.66% to 45.5%. ...
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.
... These disorders include a wide range of clinical and radiographical characteristics [6]. However, current research suggests that movement abnormalities impact the prevalence of spinal disorders and the recurrence of the disease following treatment [11,12], hence the need for a better understanding of spine kinematics to improve treatment decisions and outcomes [13,14]. ...
... Motion abnormalities of the spine impact the onset and recurrence of spinal disorders [11,12], therefore analysing the kinematics of the thoracolumbar spine gives an insight into the causes of these disorders and aids in the choice of treatment [13,14]. Stereophotogrammetric motion analysis could objectively quantify this motion [22,23], however numerous methods and protocols are found in the literature. ...
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.
... Additionally, the LSD may place greater torque on the hip than the FSD during the eccentric phase of the movement which also supports our hypothesis that positioning of the non-weightbearing leg would result in reduced flexion at the trunk and pelvis. Thus, the FSD may be an appropriate task for patients with low back pain due to a reluctance to flex the lumbar spine during stepping tasks [37]. The FSD may also be useful when practitioners are aiming to reduce hip torque in patients with FAI during rehabilitative exercises. ...
The single leg squat (SLS), forward step down (FSD), and lateral step down (LSD) are
clinically reliable movement screens for identifying motion imbalances. The current understanding for the kinematic profiles of each task is limited to discrete time points such as peak knee flexion. However, analyses of the entire movement would better aid clinicians when selecting the appropriate task for rehabilitation or movement screen purposes. The current study used Statistical Parametric Mapping to ascertain differences in the kinematic waveforms for the entire duration of each task. The trunk, pelvis, hip, and knee were analyzed in the sagittal and frontal planes. Data for each variable and task were analyzed from 0–100% of the movement. Primary findings indicated that the
FSD provoked a greater magnitude of knee abduction than the SLS and LSD from 26–66% of the movement. The SLS generated the greatest amounts of trunk, pelvic, and hip flexion for the entirety of the movement. The LSD elicited the least amount of ipsilateral trunk lean (90–100%). Thus, the FSD may be optimal for assessing frontal plane knee motion as a screen for injury risk, while the SLS has potential to place increased sagittal plane demand on the muscles of the hip.
... Grip force and tail suspension tests showed axial discomfort which is also relevant in humans and sensitivity to stretching in mice models may be predictive of lumbar stiffness as perceived in humans (204). Additionally, mice models of IVD degeneration under tail suspension tend to have decreased time immobile with more time spent mitigating pain which is similar to the human condition where humans are more likely to modify movements to avoid pain than patients without pain (200,205,206). It is noteworthy to mention that "pain" is complex and multifaceted and cannot be directly measured in animal models. ...
Low back pain is a leading cause of disability worldwide and studies have demonstrated intervertebral disc (IVD) degeneration as a major risk factor. While many in vitro models have been developed and used to study IVD pathophysiology and therapeutic strategies, the etiology of IVD degeneration is a complex multifactorial process involving crosstalk of nearby tissues and systemic effects. Thus, the use of appropriate in vivo models is necessary to fully understand the associated molecular, structural, and functional changes and how they relate to pain. Mouse models have been widely adopted due to accessibility and ease of genetic manipulation compared to other animal models. Despite their small size, mice lumbar discs demonstrate significant similarities to the human IVD in terms of geometry, structure, and mechanical properties. While several different mouse models of IVD degeneration exist, greater standardization of the methods for inducing degeneration and the development of a consistent set of output measurements could allow mouse models to become a stronger tool for clinical translation. This article reviews current mouse models of IVD degeneration in the context of clinical translation and highlights a critical set of output measurements for studying disease pathology or screening regenerative therapies with an emphasis on pain phenotyping. First, we summarized and categorized these models into genetic, age-related, and mechanically induced. Then, the outcome parameters assessed in these models are compared including, molecular, cellular, functional/structural, and pain assessments for both evoked and spontaneous pain. These comparisons highlight a set of potential key parameters that can be used to validate the model and inform its utility to screen potential therapies for IVD degeneration and their translation to the human condition. As treatment of symptomatic pain is important, this review provides an emphasis on critical pain-like behavior assessments in mice and explores current behavioral assessments relevant to discogenic back pain. Overall, the specific research question was determined to be essential to identify the relevant model with histological staining, imaging, extracellular matrix composition, mechanics, and pain as critical parameters for assessing degeneration and regenerative strategies.
... For example, positive magnetic resonance imaging (MRI) results will increase the stress of patients, and patients will change their motor behavior due to fear. [18][19][20][21] On the other hand, it is difficult to separate the influencing factors on motor behavior from lifestyle, environment, and other factors. Therefore, a more reliable method to study the relationship between IDD and motor behavior is through an animal model of IDD. ...
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.
... Since the lower limb-pelvic set is an important motor chain for the spine [7], studying the kinematic properties of the components of this kinematic chain may provide useful evidence. Some researchers suggested an association between LBP and impaired lumbar-pelvic girdle control, with an increased risk of lower limb injuries [8][9][10]. ...
Background
Low back pain (LBP) is one of the leading causes of disability worldwide. While its main cause is mostly unknown, more than 80% of people experience this disorder during their lifetime .Some clinical evidence suggests that people with chronic LBP have various lower extremity movement disorders. This study aims to systematically review the literature on comparing the kinematics of the lumbopelvic region and lower limb joints in people with non-specific low back pain (NS-LBP) compared to healthy individuals.
Methods/design
We will search main electronic databases (Medline/PubMed, Scopus, Embase, Web of Science, Pedro, ProQuest and Google Scholar) and two key journals (Journal of Electromyography and Kinesiology, Clinical Biomechanics). Also, the reference list of the previous systematic reviews would be hand-searched. Studies that have examined the kinematic differences in lumbopelvic or lower limbs between NS-LBP and healthy individuals will be included. We will examine the methodological quality and statistical reporting of each eligible trial using the Newcastle – Ottawa Scale (NOS).
Discussion
To our knowledge, this study will be the first systematic review to examine the kinematic differences of the lower limb joints and pelvic complex between healthy people and NS-LBP. Since the kinematic assessment of the lower extremities and pelvic joints during daily activities may help understand underlying factors causing LBP, it is important to evaluate the kinematic changes in these regions, during repetitive daily functions in these patients.
Systematic review registration
PROSPERO (CRD42021230826)
... Quantification of SIJ movements is a challenging task for all clinical researchers. Many conventional biomechanical models define the pelvis as a rigid segment without counting SIJ motion 13,14) . In order to establish clinical validity for the March Test, a study to investigate if a biomechanical model can quantify movement of the ilium related to the sacrum is needed. ...
... [17][18][19][20] . Because of previous evidence related to inter-rater reliability, the lumbopelvic screening and identifying of the marker positions for ASIS and PSIS were performed by the primary tester [14][15][16] . The primary tester was a board certified clinical specialist in orthopedic physical therapy with over 37 years of clinical experience in this field who did not have experience in using a motion capture system and was blinded to the algorithm to calculate SIJ movement. ...
[Purpose] The March Test (MT), evaluating hypomobility of the sacroiliac joint (SIJ), is often used in clinical practice to evaluate low back pain but has limited reported validity and reliability. Capturing the innominate movement at SIJ associated with the results of MT has not been examined. The purpose of this study was to determine if there was a significant difference in the motion of the innominate between a positive and a negative MT. [Participants and Methods] Sixteen healthy volunteers were assigned into two groups: positive or negative results of the MT. All participants were asked to perform three different tasks: standing on both limbs, static standing on one-limb and flexing the hip to 90 and 100 degrees, and active flexing the hip past 90 degrees. In a 3D motion analysis system, virtual vectors created by landmarks over the ilium defined innominate movement of the ilium related to the sacrum, which were compared between the groups. [Results] There was significantly limited innominate movement in the March Test positive group compared to the March Test negative group. [Conclusion] This study showed hypomobility at SIJ in the March test positive groups. Further investigation is needed for clinical applications.
