Disorders in trunk rotation during walking in patients with low back pain: a dynamical systems approach

Abstract

Objective. (1) To introduce an evaluation tool for the assessment of walking disorders in low back pain patients. (2) To investigate whether walking patterns in low back pain patients are different from those of control subjects. Design. Relative phase measures of movement coordination are applied in the assessment of trunk function in a small group of patients with non-specific low back pain and in control subjects. Background. Normal subjects change the coordination of pelvic and thoracic rotations from an in-phase to an out-of-phase pattern with increasing walking speed. Low back pain patients may have a reduced ability to counter rotate pelvis and thorax at higher walking speeds (from 1.0 m/s onwards) as a result of hyperstable coordination patterns. Methods. Six patients with non-specific low back pain and six healthy control subjects walked on a treadmill at comfortable walking speeds and during a systematic variation of the treadmill velocity. Coordination of arm and leg movements as well as of pelvic and thoracic rotations was analyzed using a relative phase algorithm. Results and Conclusions. The comfortable walking speed was reduced in the patient group. In contrast to the control subjects, four of the six patients were not able to establish an out-of-phase coordination pattern between thorax and pelvis at higher walking speeds. This coincided with an increased stability of movement coordination, indicating guarded behavior. In addition, an increased asymmetry between the phase-relations of left and right side of the body was found in some of the patients. Relevance The assessment of coordination between the movements of arms and legs and between rotations of pelvis and thorax during walking may be useful in the evaluation of low back pain. Further research could indicate whether this approach towards movement coordination allows for a classification of spine patients based on the influence of low back pain on gait.