Dataset Information

Does movement matter in people with back pain? Investigating 'atypical' lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors.

ABSTRACT:

Background

Interventions for low back pain (LBP) commonly target 'dysfunctional' or atypical lumbo-pelvic kinematics in the belief that correcting aberrant movement improves patients' pain and activity outcomes. If atypical kinematic parameters and postures have a relationship to LBP, they could be expected to more prevalent in people with LBP compared to people without LBP (NoLBP). This exploratory study measured, defined and compared atypical kinematic parameters in people with and without LBP.

Methods

Wireless inertial motion and EMG sensors were used to measure lumbo-pelvic kinematics during standing trunk flexion (range of motion (ROM), timing, sequence coordination, and extensor muscle activation) and in sitting (relative sitting position, pelvic tilt range) in a sample of 126 of adults without LBP and 140 chronic LBP subjects. Atypical movement was defined using the 10th/90th centiles of the NoLBP group. Mean differences and prevalence rates for atypical movement were calculated. Dichotomised pain scores for 'high-pain-on-bending' and 'high-pain-on-sitting' were tested for their association with atypical kinematic variables.

Results

For standing flexion, significant mean differences, after adjusting for age and gender factors, were seen for the LBP group with (i) reduced ROM (trunk flexion (NoLBP 111^o, LBP 93^o, p?o, LBP 46^o, p?o, LBP 48^o, p?o flexion (×?2.9), and longer movement duration (×?4.7). No differences between groups were seen for any sitting parameters. High pain intensity was significantly associated with small lumbar ROM and pelvic ROM.

Conclusion

Significant movement differences during flexion were seen in people with LBP, with a higher prevalence of small ROM, slower movement, delayed pelvic movement and greater lumbar extensor muscle activation but without differences for any sitting parameter.

SUBMITTER: Laird RA

PROVIDER: S-EPMC6339318 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

Does movement matter in people with back pain? Investigating 'atypical' lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors.

Laird Robert A RA Keating Jennifer L JL Ussing Kasper K Li Paoline P Kent Peter P

BMC musculoskeletal disorders 20190118 1

<h4>Background</h4>Interventions for low back pain (LBP) commonly target 'dysfunctional' or atypical lumbo-pelvic kinematics in the belief that correcting aberrant movement improves patients' pain and activity outcomes. If atypical kinematic parameters and postures have a relationship to LBP, they could be expected to more prevalent in people with LBP compared to people without LBP (NoLBP). This exploratory study measured, defined and compared atypical kinematic parameters in people with and wit ...[more]

PMID: 30658610

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Project description:BACKGROUND: Clinicians commonly examine posture and movement in people with the belief that correcting dysfunctional movement may reduce pain. If dysfunctional movement is to be accurately identified, clinicians should know what constitutes normal movement and how this differs in people with low back pain (LBP). This systematic review examined studies that compared biomechanical aspects of lumbo-pelvic movement in people with and without LBP. METHODS: MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2014 for relevant studies. Studies had to compare adults with and without LBP using skin surface measurement techniques to measure lumbo-pelvic posture or movement. Two reviewers independently applied inclusion and exclusion criteria, and identified and extracted data. Standardised mean differences and 95% confidence intervals were estimated for group differences between people with and without LBP, and where possible, meta-analyses were performed. Within-group variability in all measurements was also compared. RESULTS: The search identified 43 eligible studies. Compared to people without LBP, on average, people with LBP display: (i) no difference in lordosis angle (8 studies), (ii) reduced lumbar ROM (19 studies), (iii) no difference in lumbar relative to hip contribution to end-range flexion (4 studies), (iv) no difference in standing pelvic tilt angle (3 studies), (v) slower movement (8 studies), and (vi) reduced proprioception (17 studies). Movement variability appeared greater for people with LBP for flexion, lateral flexion and rotation ROM, and movement speed, but not for other movement characteristics. Considerable heterogeneity exists between studies, including a lack of detail or standardization between studies on the criteria used to define participants as people with LBP (cases) or without LBP (controls). CONCLUSIONS: On average, people with LBP have reduced lumbar ROM and proprioception, and move more slowly compared to people without LBP. Whether these deficits exist prior to LBP onset is unknown.

Project description:BackgroundMovement dysfunctions have been associated with persistent low back pain (LBP) but optimal treatment remains unclear. One possibility is that subgroups of persistent LBP patients have differing movement characteristics and therefore different responses to interventions. This study examined if there were patterns of flexion-related lumbo-pelvic kinematic and EMG parameters that might define subgroups of movement.MethodsThis was a cross-sectional, observational study of 126 people without any history of significant LBP and 140 people with persistent LBP (n = 266). Wireless motion and surface EMG sensors collected lumbo-pelvic data on flexion parameters (range of motion (ROM) of trunk, lumbar, and pelvis), speed, sequence coordination and timing, and EMG extensor muscle activity in forward bending (flexion relaxation)), and sitting parameters (relative position, pelvic tilt range and tilt ratio). Latent class analysis was used to identify patterns in these parameters.ResultsFour subgroups with high probabilities of membership were found (mean 94.9%, SD10.1%). Subgroup 1 (n = 133 people, 26% LBP) had the greatest range of trunk flexion, fastest movement, full flexion relaxation, and synchronous lumbar versus pelvic movement. Subgroup 2 (n = 73, 71% LBP) had the greatest lumbar ROM, less flexion relaxation, and a 0.9 s lag of pelvic movement. Subgroup 3 (n = 41, 83% LBP) had the smallest lumbar ROM, a 0.6 s delay of lumbar movement (compared to pelvic movement), and less flexion relaxation than subgroup 2. Subgroup 4 (n = 19 people, 100% LBP) had the least flexion relaxation, slowest movement, greatest delay of pelvic movement and the smallest pelvic ROM. These patterns could be described as standard (subgroup 1), lumbar dominant (subgroup 2), pelvic dominant (subgroup 3) and guarded (subgroup 4). Significant post-hoc differences were seen between subgroups for most lumbo-pelvic kinematic and EMG parameters. There was greater direction-specific pain and activity limitation scores for subgroup 4 compared to other groups, and a greater percentage of people with leg pain in subgroups 2 and 4.ConclusionFour subgroups of lumbo-pelvic flexion kinematics were revealed with an unequal distribution among people with and without a history of persistent LBP. Such subgroups may have implications for which patients are likely to respond to movement-based interventions.

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Project description:BackgroundPhysiotherapy for people with low back pain frequently includes assessment and modification of lumbo-pelvic movement. Interventions commonly aim to restore normal movement and thereby reduce pain and improve activity limitation. The objective of this systematic review was to investigate: (i) the effect of movement-based interventions on movement patterns (muscle activation, lumbo-pelvic kinematics or postural patterns) of people with low back pain (LBP), and (ii) the relationship between changes in movement patterns and subsequent changes in pain and activity limitation.MethodsMEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2012. Randomised controlled trials or controlled clinical trials of people with LBP were eligible for inclusion. The intervention must have been designed to influence (i) muscle activity patterns, (ii) lumbo-pelvic kinematic patterns or (iii) postural patterns, and included measurement of such deficits before and after treatment, to allow determination of the success of the intervention on the lumbo-pelvic movement. Twelve trials (25% of retrieved studies) met the inclusion criteria. Two reviewers independently identified, assessed and extracted data. The PEDro scale was used to assess method quality. Intervention effects were described using standardised differences between group means and 95% confidence intervals.ResultsThe included trials showed inconsistent, mostly small to moderate intervention effects on targeted movement patterns. There was considerable heterogeneity in trial design, intervention type and outcome measures. A relationship between changes to movement patterns and improvements in pain or activity limitation was observed in one of six studies on muscle activation patterns, one of four studies that examined the flexion relaxation response pattern and in two of three studies that assessed lumbo-pelvic kinematics or postural characteristics.ConclusionsMovement-based interventions were infrequently effective for changing observable movement patterns. A relationship between changes in movement patterns and improvement in pain or activity limitation was also infrequently observed. No independent studies confirm any observed relationships. Challenges for future research include defining best methods for measuring (i) movement aberrations, (ii) improvements in movements, and (iii) the relationship between changes in how people move and associated changes in other health indicators such as activity limitation.

Dataset Information

Does movement matter in people with back pain? Investigating 'atypical' lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors.

Background

Methods

Results

Conclusion

Publications

Does movement matter in people with back pain? Investigating 'atypical' lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors.

Similar Datasets

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