Abstract
Objective. The primary purpose of this paper was to evaluate the influence of pain distribution on gait characteristics in subjects with low back problems (LBP) during walking at preferred and fastest speeds. Design. Cross-sectional, observational study. Setting. Gait analysis laboratory in a health professions university. Participants. A convenience age- and gender-matched sample of 20 subjects with back pain only (BPO), 20 with referred leg pain due to back problems (LGP), and 20 pain-free individuals (CON). Methods and Measures. Subjects completed standardized self-reports on pain and disability and were videotaped as they walked at their preferred and fastest speeds along a walkway embedded with a force plate. Temporal and spatial gait characteristics were measured at the midsection of the walkway, and peak medial, lateral, anterior, and posterior components of horizontal ground reaction forces (hGRFs) were measured during the stance phase. Results. Patients with leg pain had higher levels of pain intensity and affect compared to those with back pain only (t = 4.91, P < .001 and t = 5.80, P < 0.001, resp.) and walking had an analgesic effect in the BPO group. Gait velocity was highest in the control group followed by the BPO and LGP group and differed between groups at both walking speeds (F 2.57 = 13.62, P < .001 and F 2.57 = 9.09, P < .001, for preferred and fastest speed condition, resp.). When normalized against gait velocity, the LGP group generated significantly less lateral force at the fastest walking speed (P = .005) and significantly less posterior force at both walking speeds (P ≤ .01) compared to the control group. Conclusions. Pain intensity and distribution differentially influence gait velocity and hGRFs during gait. Those with referred leg pain tend to utilize significantly altered gait strategies that are more apparent at faster walking speeds.
Highlights
Low back pain (LBP) remains a prevalent and persistent problem that frequently compromises physical function, including walking
We have previously demonstrated that self-report of disability and several gait characteristics are differentially influenced by pain distribution, by walking speed [8], and by walking condition [16]
In another study [8], we showed that individuals with low back problems (LBP) and leg pain (LGP) prefer to walk more slowly compared to those with back pain only (BPO) or with an age- and gendermatched cohort, respectively
Summary
Low back pain (LBP) remains a prevalent and persistent problem that frequently compromises physical function, including walking. Some people with LBP will remain active, others have difficulty doing so for a variety of physical, psychological and social reasons [5], and this can contribute to the individual’s distress and disability and the economic cost of chronic LBP [6]. Given the fundamental nature of walking and the fact that it is an oft prescribed activity for patients with LBP, it is clearly important to have a better understanding of the effect of pain on walking. Walking is a complex dynamic task that is fundamental to function and that requires an individual to generate and withstand a variety of multidirectional forces around each joint and with the ground, that is, ground reaction forces
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