Abstract
BACKGROUNDLiterature describing differences in motor control between low back pain (LBP) patients and healthy controls is very inconsistent, which may be an indication for the existence of subgroups. Pain-related psychological factors might play a role causing these differences. PURPOSETo examine the relation between fear of movement and variability of kinematics and muscle activation during gait in LBP patients. STUDY DESIGNCross-sectional experimental design. PATIENT SAMPLEThirty-one Chinese LBP patients. OUTCOME MEASURESSelf-report measures: Visual Analog Score for pain; TAMPA-score; Physiologic measures: electromyography, range of motion. FUNCTIONAL MEASURESLBP history; the physical load of profession, physical activity. METHODSPatients were divided in high and low fear of movement groups. Participants walked on a treadmill at four speeds: very slow, slow, preferred and fast. Kinematics of the thorax and the pelvis were recorded, together with the electromyography of five bilateral trunk muscle pairs. Kinematic and electromyography data were analysed in terms of stride-to-stride pattern variability. Factor analysis was applied to assess interdependence of 11 variability measures. To test for differences between groups, a mixed-design multivariate analysis of variance was conducted. RESULTSKinematic variability and variability of muscle activation consistently loaded on different factors and thus represented different underlying variables. No significant Group effects on variability of kinematics and muscle activation were found (Hotelling's Trace F=0.237; 0.396, p=.959; .846, respectively). Speed significantly decreased kinematic variability and increased variability in muscle activation (Hotelling's Trace F=8.363; 4.595, p<.0001; <.0001, respectively). No significant interactions between Group and Speed were found (Hotelling's Trace F=0.204; 0.100, p=.762; .963, respectively). CONCLUSIONSThe results of this study do not support the hypothesis that variability in trunk kinematics and trunk muscle activation during gait in LBP patients are associated with fear of movement.
Highlights
MethodsLow back pain (LBP) is the number one disabling pathology world-wide [1]; about 80% of all adults will suffer from low back pain (LBP) at some point in their life, of which 20% will develop chronic LBP, defined as pain that persists for 12 weeks or longer [2]
A recent study indicated that motor control issues are predictive of disability in chronic LBP patients [3] and systematic reviews [4−6] have concluded that motor control exercise is moderately effective in treating these patients
The variability of the kinematics and muscle activation were consistently projected on different factors and this was clearer at higher speeds, indicating that variability of kinematics and variability of muscle activation present largely independent information
Summary
MethodsLow back pain (LBP) is the number one disabling pathology world-wide [1]; about 80% of all adults will suffer from LBP at some point in their life, of which 20% will develop chronic LBP, defined as pain that persists for 12 weeks or longer [2]. A recent study indicated that motor control issues are predictive of disability in chronic LBP patients [3] and systematic reviews [4−6] have concluded that motor control exercise is moderately effective in treating these patients. These reviews suggest that further research should determine which subgroups of LBP patients respond best to motor control exercise [4−6]. Results were quite inconsistent, with some studies reporting differences between patients and controls, and other studies reporting no differences, or even opposite findings [7−11] As an example, both increased and decreased variability of trunk movement of gait in LBP patients compared to healthy controls have been reported [12−16]. Van Die€en et al [7] proposed that the inconsistency in findings on variability might reflect the existence of two subgroups: a group with ‘tight’ control, who were suggested to respond to pain with an attempt to tighten control over trunk movement, and a ‘loose’ control group, in whom pain interferes with the precision of motor control
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