Document Type : Original Research

Authors

1 Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran

Abstract

Background: Chronic low back pain (CLBP) disability has been particularly frustrating because its treatment has been a great therapeutic challenge. Disability has been suggested to depend on different factors that should be found and considered in the medical management. The inter-segmental coordination is often impaired in CLBP subjects; however, to the best of our knowledge, there is no evidence about the relationship between the existence of coordination problems and disability in CLBP patients.Objective: To evaluate the correlation between sagittal plane trunk-pelvis inter-segmental coordination parameters during walking and disability level in CLBP patients.Methods: Kinematic data were collected from 16 non-specific CLBP (18-40 years) volunteers during walking. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Coordination parameters, mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis coordination pattern and variability during gait cycles, respectively. The disability level was quantified through Oswestry Disability Index (ODI) questionnaire. Pearson correlation coefficient was used to find the probable correlation between coordination parameters and disability level.Results: The analysis demonstrated a significant correlation between sagittal plane MARP or DP and disability level (%ODI) in CLBP subjects during walking (r= -0.806 P

Keywords

  1. Lawford BJ, Walters J, Ferrar K. Does walking improve disability status, function, or quality of life in adults with chronic low back pain? A systematic review. Clin Rehabil. 2016;30:523-36. doi.org/10.1177/0269215515590487. PubMed PMID: 26088673.
  2. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581-5. doi.org/10.1016/S0140-6736(99)01312-4. PubMed PMID: 10470716.
  3. White AA, 3rd, Gordon SL. Synopsis: workshop on idiopathic low-back pain. Spine (Phila Pa 1976). 1982;7:141-9. doi.org/10.1097/00007632-198203000-00009. PubMed PMID: 6211779.
  4. Waddell G, Main CJ. Assessment of severity in low-back disorders. Spine (Phila Pa 1976). 1984;9:204-8. doi.org/10.1097/00007632-198403000-00012. PubMed PMID: 6233713.
  5. Hazard RG, Haugh LD, Green PA, Jones PL. Chronic low back pain: The relationship between patient satisfaction and pain, impairment, and disability outcomes. Spine (Phila Pa 1976). 1994;19:881-7. doi.org/10.1097/00007632-199404150-00003. PubMed PMID: 8009344.
  6. Steele J, Bruce-Low S, Smith D, Jessop D, Osborne N. Lumbar kinematic variability during gait in chronic low back pain and associations with pain, disability and isolated lumbar extension strength. Clin Biomech (Bristol, Avon). 2014;29:1131-8. doi.org/10.1016/j.clinbiomech.2014.09.013. PubMed PMID: 25451860.
  7. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157-68. doi.org/10.1016/0304-3959(93)90127-B. PubMed PMID: 8455963.
  8. Vogt L, Pfeifer K, Portscher, Banzer W. Influences of nonspecific low back pain on three-dimensional lumbar spine kinematics in locomotion. Spine (Phila Pa 1976). 2001;26:1910-9. doi.org/10.1097/00007632-200109010-00019. PubMed PMID: 11568705.
  9. Lamoth CJ, Meijer OG, Daffertshofer A, Wuisman PI, Beek PJ. Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control. Eur Spine J. 2006;15:23-40. doi.org/10.1007/s00586-004-0825-y. PubMed PMID: 15864670. PubMed PMCID: 3454567.
  10. Lamoth CJ, Daffertshofer A, Meijer OG, Beek PJ. How do persons with chronic low back pain speed up and slow down? Trunk-pelvis coordination and lumbar erector spinae activity during gait. Gait Posture. 2006;23:230-9. doi.org/10.1016/j.gaitpost.2005.02.006. PubMed PMID: 16399520.
  11. Seay JF, Van Emmerik RE, Hamill J. Low back pain status affects pelvis-trunk coordination and variability during walking and running. Clin Biomech (Bristol, Avon). 2011;26:572-8. doi.org/10.1016/j.clinbiomech.2010.11.012. PubMed PMID: 21536356.
  12. Yen HC, Chen HL, Liu MW, Liu HC, Lu TW. Age effects on the inter-joint coordination during obstacle-crossing. J Biomech. 2009;42:2501-6. doi.org/10.1016/j.jbiomech.2009.07.015. PubMed PMID: 19665128.
  13. Hamill J, McDermott WJ, Haddad JM. Issues in quantifying variability from a dynamical systems perspective. Journal of Applied Biomechanics. 2000;16(4). doi.org/10.1123/jab.16.4.407.
  14. Bernstein NA. The co-ordination and regulation of movements. Pergamon Press: Oxford; 1967.
  15. Hutin E, Pradon D, Barbier F, Gracies JM, Bussel B, Roche N. Lower limb coordination patterns in hemiparetic gait: factors of knee flexion impairment. Clin Biomech (Bristol, Avon). 2011;26:304-11. doi.org/10.1016/j.clinbiomech.2010.10.007. PubMed PMID: 21074912.
  16. Ghanavati T, Salavati M, Karimi N, Negahban H, Ebrahimi Takamjani I, Mehravar M, et al. Intra-limb coordination while walking is affected by cognitive load and walking speed. J Biomech. 2014;47:2300-5. doi.org/10.1016/j.jbiomech.2014.04.038. PubMed PMID: 24861632.
  17. Kelso JS. Dynamic patterns: The self-organization of brain and behavior. London: MIT press; 1997.
  18. Hamill J, van Emmerik RE, Heiderscheit BC, Li L. A dynamical systems approach to lower extremity running injuries. Clin Biomech (Bristol, Avon). 1999;14:297-308. doi.org/10.1016/S0268-0033(98)90092-4. PubMed PMID: 10521606.
  19. Mokhtarinia HR, Sanjari MA, Chehrehrazi M, Kahrizi S, Parnianpour M. Trunk coordination in healthy and chronic nonspecific low back pain subjects during repetitive flexion-extension tasks: Effects of movement asymmetry, velocity and load. Hum Mov Sci. 2016;45:182-92. doi.org/10.1016/j.humov.2015.11.007. PubMed PMID: 26684726.
  20. Worster K, Valvano J, Carollo JJ. Sagittal plane coordination dynamics of typically developing gait. Clin Biomech (Bristol, Avon). 2015;30:366-72. doi.org/10.1016/j.clinbiomech.2015.02.013. PubMed PMID: 25753695.
  21. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15:S192-300. doi.org/10.1007/s00586-006-1072-1. PubMed PMID: 16550448. PubMed PMCID: 3454542.
  22. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions. Spine (Phila Pa 1976). 2006;31:E454-9. doi.org/10.1097/01.brs.0000222141.61424.f7. PubMed PMID: 16778675.
  23. Ciccone DS, Just N, Bandilla EB. Non-organic symptom reporting in patients with chronic non-malignant pain. Pain. 1996;68:329-41. doi.org/10.1016/S0304-3959(96)03216-2. PubMed PMID: 9121822.
  24. Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66:271-3. PubMed PMID: 6450426.
  25. Desailly E, Daniel Y, Sardain P, Lacouture P. Foot contact event detection using kinematic data in cerebral palsy children and normal adults gait. Gait Posture. 2009;29:76-80. doi.org/10.1016/j.gaitpost.2008.06.009. PubMed PMID: 18676147.
  26. Chiu SL, Chou LS. Effect of walking speed on inter-joint coordination differs between young and elderly adults. J Biomech. 2012;45:275-80. doi.org/10.1016/j.jbiomech.2011.10.028. PubMed PMID: 22078272.
  27. Meyns P, Van Gestel L, Bruijn SM, Desloovere K, Swinnen SP, Duysens J. Is interlimb coordination during walking preserved in children with cerebral palsy? Res Dev Disabil. 2012;33:1418-28. doi.org/10.1016/j.ridd.2012.03.020. PubMed PMID: 22522200.
  28. Stergiou N, Jensen JL, Bates BT, Scholten SD, Tzetzis G. A dynamical systems investigation of lower extremity coordination during running over obstacles. Clin Biomech (Bristol, Avon). 2001;16:213-21. doi.org/10.1016/S0268-0033(00)00090-5. PubMed PMID: 11240056.
  29. Kovacs FM, Abraira V, Zamora J, Teresa Gil del Real M, Llobera J, Fernandez C, et al. Correlation between pain, disability, and quality of life in patients with common low back pain. Spine (Phila Pa 1976). 2004;29:206-10. doi.org/10.1097/01.BRS.0000107235.47465.08. PubMed PMID: 14722416.
  30. Vlaeyen JW, Crombez G. Fear of movement/(re)injury, avoidance and pain disability in chronic low back pain patients. Man Ther. 1999;4:187-95. doi.org/10.1054/math.1999.0199. PubMed PMID: 10593107.
  31. Radin EL, Yang KH, Riegger C, Kish VL, O’Connor JJ. Relationship between lower limb dynamics and knee joint pain. J Orthop Res. 1991;9:398-405. doi.org/10.1002/jor.1100090312. PubMed PMID: 2010844.
  32. Arendt-Nielsen L, Graven-Nielsen T, Svarrer H, Svensson P. The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study. Pain. 1996;64:231-40. doi.org/10.1016/0304-3959(95)00115-8. PubMed PMID: 8740599.
  33. Newcomer KL, Jacobson TD, Gabriel DA, Larson DR, Brey RH, An KN. Muscle activation patterns in subjects with and without low back pain. Arch Phys Med Rehabil. 2002;83:816-21. doi.org/10.1053/apmr.2002.32826. PubMed PMID: 12048661.
  34. Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S. The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine (Phila Pa 1976). 2000;25:989-94. doi.org/10.1097/00007632-200004150-00015. PubMed PMID: 10767813.
  35. Khamis S, Yizhar Z. Effect of feet hyperpronation on pelvic alignment in a standing position. Gait Posture. 2007;25:127-34. doi.org/10.1016/j.gaitpost.2006.02.005. PubMed PMID: 16621569.
  36. Bouisset S. Relationship between postural support and intentional movement: biomechanical approach. Arch Int Physiol Biochim Biophys. 1991;99:A77-92. doi.org/10.3109/13813459109145919. PubMed PMID: 1720694.