Low Back Pain Group Research Articles

Organization factors influencing quality of work life among seniors' care workers with severe low back pain.

The prevalence of work-related low back pain (LBP) is high among care workers and can negatively affect quality of work life (QWL). To improve workplace satisfaction, this study aimed to identify factors influencing QWL among seniors' care workers with severe LBP. A questionnaire survey including items on demographics, qualifications, basic job responsibilities, job stressors, LBP severity, QWL, and job satisfaction was conducted in 2018. In total, 1000 senior care facilities were selected via random sampling and eight care workers per institution were asked to complete the survey. Multiple logistic regression analysis was used to identify independent factors influencing QWL of care workers with and without severe LBP. Data from 1247 care workers with severe LBP and 2009 with nonsevere LBP were included in the analysis. Overall QWL was lower in the severe LBP group than in the nonsevere LBP group. In both groups, human relationships, workplace support, discretionary responsibility level, and working hours or time off were identified as common factors influencing QWL. In the severe LBP group, the salary was also a significant influence on QWL, while in the nonsevere LBP group, the number of workers, promotion or official position, and caregiving technique were identified as significant QWL factors. The QWL of care workers with severe LBP was strongly influenced by salary. Since care workers suffering from severe LBP are working for a salary while enduring the pain and do not have found a worth doing, they need to prevent LBP and get job satisfaction and self-progress.

Static balance and its association with pain and disability in females with low back pain – a pilot cross-sectional study

Introduction: Research on low back pain (LBP) indicates sex differences in the prevalence and degree of disability, which is more significant in females and shows possible balance deficiencies. This study aimed to answer the following research questions: (i) is there a difference in static balance between healthy and females with LBP, (ii) is there a correlation between pain and static balance in females with LBP, and (iii) is there a correlation between static balance and disability in females with LBP. Methods: A cross-sectional research was conducted in a physiotherapy outpatient setting on a sample of 50 subjects, females with LBP and healthy volunteers, divided into two equal groups. Data collected from all respondents were: age, weight and height, the centre of pressure path length and rectangle area, Romberg area quotient and space quotient measured via a stabilometric force platform. In the LBP group, the pain was assessed using the Numeric Pain Rating Scale, and disability was assessed using the 24-item Roland Morris Disability Questionnaire. Nonparametric statistical tests were used: the Mann-Whitney test (i) and the Spearman correlation coefficient (ii and iii) with a defined significance level set at p<0.05. Results: Statistical analysis revealed (i) a difference in static balance between healthy females and those with LBP, (iii) a correlation between disability and static balance and (ii) no correlation between pain and static balance in LBP. Conclusion: Females with LBP have static balance deficiencies, which are correlated with their disability but not with pain which should be considered during physiotherapy.

Assessment of Hip Range of Motion Limitations in Cases with Low Back Pain Based on the Classified Movement System Impairment.

The hip joint's limitation causes lumbopelvic compensatory motions, accumulating tissue stress on the lumbar spines. It is essential and valuable to evaluate hip rotation range of motion (ROM) in different low back pain (LBP) classifications to understand them and plan the best exercise program. This study aimed to compare hip rotation ROM between subjects with and without LBP classified in movement system impairment (MSI). In this cross-sectional study, 100 subjects with LBP were classified into different MSI subgroups (mean age of 41.66 ± 7.82 years), and 100 healthy subjects (mean age of 38.96 ± 8.84 years) participated. Passive and active hip medial and lateral rotations ROM in prone and supine positions for dominant and non-dominant lower limbs were measured. Generally, in the LBP group, minimal lateral rotation as compared to controls in movement tests measuring hip rotation ROM actively and passively, in prone and sitting positions, and for dominant and non-dominant limbs (P < 0.05). There were no significant differences among the LBP subgroups (P > 0.05). Due to LBP, regardless of the MSI categories, remarkably restricted hip lateral rotation ROM.

Is low back pain related to the body composition, flexibility, and postural deviations in rural workers?

Hard work in the countryside can lead to the onset of pain conditions, which in turn trigger different degrees of labor reduction and musculoskeletal disorders. Low back pain is one of the most common disorders that lead to inactivity, and obesity seems to be associated with the development of low back pain symptoms, since abdominal fat causes mechanical demands in this region due to excessive load. To analyze low back pain and its relationship with body composition, flexibility, and posture in rural workers. Rural workers (n = 55) were grouped according to the presence of low back pain or absence of low back pain symptoms. Body composition, flexibility, and posture were assessed and compared between groups. A principal component analysis was used to group variables to identify possible associations among variables and low back pain. The low back pain group presented greater obesity rates than the group without symptoms. Regarding low back pain prevalence, most of the participants had pain symptoms and showed postural deviations. Principal components analysis showed that the group without symptoms was mainly related to the amount of muscle tissue, while the low back pain group was to the adipose tissue. Low back pain appears to be associated with body composition and postural deviations, while musculoskeletal and adipose tissues are protective and risk factors for low back pain, respectively, in rural workers.

Differences in joint angles during pole vaulting between male pole vaulters with and without chronic low back pain

Abstract Study aim: To determine the difference in joint angles of the shoulder, hip, and trunk (angle of the upper torso and lower torso) during vaulting between male pole vaulters with and without chronic low back pain (LBP) and to examine the relationship between the range of motion (ROM) and maximum angle of the same joint during vaulting in all participants. Material and methods: This cross-sectional study included 17 male vaulters. The participants were divided into two groups (chronic LBP and control) based on their questionnaire results. Four high-speed cameras were used to record at 240 Hz from the touchdown of the last step on the run-up to the pole straight phase. The vaulter cleared the bungee bars that were set at 90% of their personal best record. The ROM of hip flexion and extension, shoulder flexion, and straight leg raise were measured. Results: There was no difference in the joint angles between the chronic LBP group and control group. In contrast, there was a significantly positive correlation between ROM and the maximum joint angle during hip extension (p = 0.01, r = 0.58). Conclusions: Insufficient hip ROM may result in compensatory motion in lumbar extension during pole vaulting.

Distinction of non-specific low back pain patients with proprioceptive disorders from healthy individuals by linear discriminant analysis.

The central nervous system (CNS) dynamically employs a sophisticated weighting strategy of sensory input, including vision, vestibular and proprioception signals, towards attaining optimal postural control during different conditions. Non-specific low back pain (NSLBP) patients frequently demonstrate postural control deficiencies which are generally attributed to challenges in proprioceptive reweighting, where they often rely on an ankle strategy regardless of postural conditions. Such impairment could lead to potential loss of balance, increased risk of falling, and Low back pain recurrence. In this study, linear and non-linear indicators were extracted from center-of-pressure (COP) and trunk sagittal angle data based on 4 conditions of vibration positioning (vibration on the back, ankle, none or both), 2 surface conditions (foam or rigid), and 2 different groups (healthy and non-specific low back pain patients). Linear discriminant analysis (LDA) was performed on linear and non-linear indicators to identify the best sensory condition towards accurate distinction of non-specific low back pain patients from healthy controls. Two indicators: Phase Plane Portrait ML and Entropy ML with foam surface condition and both ankle and back vibration on, were able to completely differentiate the non-specific low back pain groups. The proposed methodology can help clinicians quantitatively assess the sensory status of non-specific low back pain patients at the initial phase of diagnosis and throughout treatment. Although the results demonstrated the potential effectiveness of our approach in Low back pain patient distinction, a larger and more diverse population is required for comprehensive validation.

The dynamic postural steadiness and stabilization time between older adults with and without recurrent low back pain

BackgroundAlthough postural control measures were reported to identify neuromuscular impairments, postural steadiness and stabilization time were not carefully investigated between subjects with and without recurrent low back pain (LBP).Research QuestionAre there group differences in the stabilization time, direction of sway, and dynamic postural steadiness index (DPSI) during one-leg standing? MethodsThirty-four control subjects and 29 subjects with recurrent LBP participated in the study. Each subject stood upright on a single leg with and without visual input. The outcomes were measured for standing duration (sec), direction of sway, and the DPSI, which included the vertical steadiness index (VSI). The VSI assesses fluctuations to standardize the vertical ground reaction forces on the force plate. ResultsThe control group demonstrated significantly longer standing duration compared to the LBP group during the eyes-open condition (t = 3.55, p = 0.001). The LBP group demonstrated significantly faster stabilization time (t = 2.53, p = 0.01) in the sagittal plane. The DPSI demonstrated an excellent relationship with the VSI without visual input in the control group (r = 0.98, p = 0.001). The directions of sway demonstrated a significant interaction between groups (F = 9.29, p = 0.004). SignificanceAlthough standing duration in the eyes-open condition decreased in the LBP group, a faster stabilization time in the sagittal plane was evident compared to the control group to adapt postural stability. These results indicated that vertical dynamic steadiness with visual input might be important to enhance compensatory postural control.

The morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation

ObjectiveThe objective of this study was to explore the morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation.MethodsThis study retrospectively analyzed young patients aged 18–40 years who were hospitalized for lumbar disc herniation in our hospital from June 2017 to June 2020. Data on sex, age, body mass index (BMI), subcutaneous fat tissue thickness (SFTT) at the L1-L2 level, duration of symptoms, degree of lumbar disc herniation, visual analog scale (VAS) for the lower back, Mo-fi-disc score, relative cross-sectional area (RCAS) of the paravertebral muscles (psoas major [PM], multifidus [MF], and erector spinae [ES]), and degree of fat infiltration (DFF) of the paravertebral muscles were collected. The VAS was used to evaluate the intensity of low back pain. Patients with VAS-back >4 points were defined as the low back pain group, and patients with ≤4 points were defined as the control group. The demographic characteristics, as well as the bilateral and ipsilateral paravertebral muscles, of the two groups were compared and analyzed.ResultA total of 129 patients were included in this study (52 patients in the LBP group and 77 patients in the control group). There were no significant differences in sex, BMI, or Pfirrmann grade of lumbar disc herniation between the two groups (P > 0.05). The age of the LBP group (33.58 ± 2.98 years) was greater than that of the control group (24.13 ± 2.15 years) (P = 0.002), and the SFTT at the L1-L2 level (13.5 ± 7.14 mm) was higher than that of the control group (7.75 ± 6.31 mm) (P < 0.05). Moreover, the duration of symptoms (9.15 ± 0.31 months) was longer than that of the control group (3.72 ± 0.48 months) (P < 0.05), and the Mo-fi-disc score (8.41 ± 3.16) was higher than that of the control group (5.53 ± 2.85) (P < 0.05). At L3/4 and L5/S1, there was no significant difference in the RCSA and DFF of the bilateral and ipsilateral paraspinal muscles between the LBP group and the control group. At L4/5, there was no significant difference in the RCSA and DFF of the paraspinal muscles on either side in the LBP group (P > 0.05). In the control group, the RCSA of the MF muscle on the diseased side was smaller than that on the normal side (P < 0.05), and the DFF of the MF muscle on the diseased side was larger than that on the normal side (P < 0.05). In addition, there was no significant difference in the ES and PM muscles on both sides (P > 0.05). At L4/5, the RCSA of the MF muscle on the normal side was significantly smaller in the LBP group than in the control group (P < 0.05), and the DFF of the MF muscle on the normal side was significantly larger in the LBP group than in the control group (P < 0.05). There was no significant difference in the ES and PM muscles on the same side between the two groups (P > 0.05).ConclusionIn young patients with unilateral neurological symptoms of lumbar disc herniation, symmetrical atrophy of the bilateral MF muscle is more prone to causing low back pain. Older age, higher SFTT at the L1-L2 levels, longer symptom duration, higher Mo-fi-di score, and greater muscle atrophy on the normal side of the MF increased the incidence of low back pain in young patients with unilateral lumbar disc herniation.

Limited evidence of altered gait parameters in people with chronic nonspecific low back pain

BackgroundDifferences in gait parameters have been shown between people with and without low back pain (LBP). However, previous studies did not well control factors such as sex, age, height and walking speed known to influence gait parameters. Research questionIs gait altered in people with LBP when sex, age, height and walking speed are controlled? MethodsA series of gait parameters were measured in 16 participants with LBP and 16 age, sex and height matched healthy controls while walking on an instrumented treadmill. LBP group walked at a comfortable speed whilst control group walked at their own comfortable speed and at the comfortable speed of their matched participants with LBP. Pain and disability were measured for the LBP group. The between-group differences in mean, standard deviation (SD) and coefficient of variation (CV) of gait parameters were tested using paired samples t-test, Wilcoxon signed-rank test or two-factor repeated measures analyses of variance. ResultsThe median (interquartile range) of pain intensity was 2 (1, 3.5). From 102 tests of between-group difference in mean, SD and CV of 17 gait parameters at both comfortable speed and matched speed walking, only the mean of stride length (p = 0.037) during matched speed walking and SD of single support phase (p = 0.040) during comfortable speed walking showed significant between-group differences. There was no significant between-group difference in the rest means (comfortable walking: p ≥ 0.116; matched speed walking: p ≥ 0.069), SDs (comfortable walking: p ≥ 0.066; matched speed walking: p ≥ 0.098) and CVs of gait parameters (comfortable walking: p ≥ 0.110; matched speed walking: p ≥ 0.121). SignificanceThe lack of significant between-group difference in gait parameters may suggest that the gait of people with low level of LBP were not altered when sex, age and height were controlled.

Lower Quadrant Swing Biomechanics Identifies Golfers With Increased Risk of Low Back Pain: A Prospective Longitudinal Cohort Study.

Elite golfers have a high incidence of low back pain. Recent reviews have emphasized the need for investigation into how to prevent low back pain in golfers, prompting the current study. Prospective longitudinal cohort study. Forty-one injury-free golfers were included in this study. At baseline, lower quadrant joint angles and club and ball performance were measured while each golfer performed 10 drives. The golfers were then monitored for 6months and were allocated into 2 groups depending on whether or not they developed low back pain. The initial, baseline kinematic variables of the low back pain group and the uninjured group were then compared. Over the 6-month monitoring period, 17 (41%) of the golfers developed low back pain. At baseline assessment, the low back pain group had 4° less lead ankle dorsiflexion at setup (P = .01; effect size = 0.82), 6° less lead knee flexion at the top of the backswing (P = .05; effect size = 0.64), 6° less lead ankle dorsiflexion at the top of the backswing (P = .01; effect size = 0.82), 6° more trail hip adduction at the top of the backswing (P = .02; effect size = 0.79), 9° more trail knee flexion at impact (P = .05; effect size = -0.64), and 6° more trail hip adduction at the end of follow through (P < .00; effect size = 1.00). Golfers who developed low back pain during the 6-month monitoring period displayed distinct differences in biomechanics at baseline when all golfers were injury free. These biomechanical differences may be considered a precursor to injury. Three-dimensional motion analysis may indicate whether elite golfers are at risk of developing low back pain. Research is needed to assess whether targeted exercise and sports drills aimed at addressing the biomechanical risk factors identified may prevent low back pain in elite golfers.

Prevalence of low back pain and its associated risk factors among professions and workers in health, medical, and welfare facilities in Japan.

The prevalence of low back pain (LBP) and its associated risk factors, including physical function, are not fully clarified among health, medical, and welfare facility professionals and workers. Furthermore, issues related to the prevention of LBP are not completely understood. To investigate the prevalence of LBP and associated risk factors, including physical function, in professionals and workers in health, medical, and welfare facilities. Cross-sectional study. Physical examinations for LBP were conducted, and data were collected at health, medical, and welfare facilities in Japan. A total of 1085 health, medical, and welfare facility professionals and workers participated in the study. Prevalence was calculated based on the presence or absence of symptoms of LBP at the time of survey. Then, bivariate analysis was conducted to examine the relationship between LBP and age, gender, occupation, history of treatment for LBP, passive straight leg raising (SLR) angle, and abdominal muscle strength. Furthermore, multivariate analysis was performed to examine the relationship between LBP and the six risk factors. The prevalence of LBP was high (74.8%). Bivariate analysis showed a significantly higher percentage of nursing professionals (46.2%) in the LBP group (p< .001). The association between LBP and the risk factors in multivariate analysis was as follows: history of treatment for LBP (odds ratio [OR]=3.92, 95% confidence interval [CI] 2.63-5.84, p< .001), nursing professionals as occupation (OR=2.12, 95% CI 1.55-2.90, p< .001), passive SLR angle (OR=2.06, 95% CI 1.24-3.42, p= .005), abdominal muscle strength (OR=1.61, 95% CI 1.07-2.41, p= .021), and gender (OR=1.52, 95% CI 1.08-2.14, p= .015). In the future, it will be necessary to take preventive measures for risk factors and to follow up longitudinally on the prevalence of LBP and on workers with indicated risk factors.

The effect of fatigue on electromechanical response times in basketball players with and without persistent low back pain

Typically, athletes alter movement mechanics in the presence of back pain, but the effect of these changes on lower extremity injury risk is not well understood. This study aimed to compare the effect of fatigue on electromechanical response times during a choice reaction task in basketball players with and without persistent low back pain. Twenty-four male basketball players participated. Total reaction time (TRT), premotor time (PMT), and electromechanical delay (EMD data were recorded before and after fatigue. The chronic low back pain (CLBP) group had significantly longer EMD in Med gastrocnemius (p = 0.001) and Tibialis anterior (p = 0.001), and shorter EMD in Vastus Lateralis (p = 0.001), Vastus Medialis Oblique (p = 0.003), and Semitendinosus (p = 0.025) muscles after fatigue. PMT in the CLBP group had longer than the Non-CLBP in Vastus Lateralis (p = 0.010), Vastus Medialis Oblique (p = 0.017), Semitendinosus (p = 0.002). Also, TRT was longer in knee flexion (p = 0.001) and ankle plantarflexion (p = 0.001) muscle groups. The different effects of fatigue on electromechanical response times of the knee and ankle in people with CLBP may represent the effect of an axial injury on lower extremity injury risk factors in situations of higher cognitive load, similar to competitive play.

Ultrasound evidence of altered lumbar fascia in patients with low back pain.

Different hypotheses have been proposed about the role of lumbar connective tissue in low back pain (LBP). However, none of the previous studies have examined the change in the elastic behavior of lumbar fascia in patients with LBP. The present study aimed to evaluate the changes in the elastic behavior of lumbar fascia in patients with chronic non-specific LBP based on ultrasound imaging. The sonographic strain imaging assessed the thoracolumbar fascia (TLF) of 131 human subjects (68 LBP and 63 non-LBP). Assessments were done at L2-L3 and L4-L5 levels bilaterally. The points were located 2 cm lateral to the midpoint of the interspinous ligament. There were no significant differences in age, sex, and BMI between LBP and healthy individuals. There is a strong inverse relationship between pain severity (r= -0.76, n= 68, p= 0.004) and the TLF elastic modulus coefficient. No significant relationship were observed between age (r= 0.053, n= 68, p= 0.600), BMI (r= -0.45, n= 68, p= 0.092), and gender (r= -0.09, n= 68, p= 0.231) with the TLF elasticity coefficient. The LBP group had a 25%-30% lower TLF elastic modulus coefficient than healthy individuals. The present study is the first to evaluate the elastic coefficient of TLF using the ultrasound imaging method. The study results showed that the TLF elastic coefficient in patients with LBP was reduced compared to healthy individuals and directly related to LBP severity.

Relationship between Facial Color Changes and Psychological Problems Associated with Lower Back Pain.

Background and Objectives: The aim of this study was to determine whether a non-contact sensor that detects complexion changes can be used to assess the psychological state of patients with chronic lower back pain (LBP). Materials and Methods: Twenty-six patients with LBP (LBP group; mean age = 68.0 ± 13.9 years) and 18 control subjects without LBP (control group; mean age = 60.8 ± 16.1 years) were included in the study. All the subjects in the two groups wore headphones when asked LBP-related and LBP-unrelated questions. During questioning, the facial image of the subjects was captured using a video camera, and the complexion of the subjects was converted into red, green, and blue (RGB) values. RGB correlation coefficients (RGBCCs; range: 0–1) represent the difference in complexion between LBP-related and LBP-unrelated questions. A high RGBCC indicates that the brain is more activated by LBP-related questions than by LBP-unrelated questions. We also noted the scores of subjects on the Numerical Rating Scale (NRS), Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS). Results: There were no significant differences in RGBCC between the control and LBP groups (0.64 versus 0.56, p = 0.08). In the LBP group, no correlation was observed between RGBCC and each examination item of NRS, JOABPEQ, and HADS. In contrast, a correlation was observed between RGBCC and the rumination subscale of PCS in the LBP group (Spearman’s rank correlation coefficient = 0.40, p = 0.04). Conclusions: The complexion of patients with catastrophic thinking changes when the patients are asked LBP-related questions.

Comparisons of lumbar spine loads and kinematics in healthy and non-specific low back pain individuals during unstable lifting activities

Evaluation of spinal loads in patients with low back pain (LBP) is essential to prevent further lumbar disorders. Many studies have investigated the relationship between lifting task variables and lumbar spine loads during manual lifting activities. The nature of the external load (stable versus unstable loads) is an important variable that has received less attention. Therefore, the present study aimed to measure trunk kinematics and estimate compressive-shear loads on the lumbar spine under lifting a 120 N stable load and 120 ± 13.63 N sensual unstable load in 16 healthy and 16 non-specific LBP individuals during lifting activities. The maximal lumbar loads were estimated using a quasi-static electromyography (EMG)-driven musculoskeletal model of the spine with 18 degrees of freedom (3 rotational degrees of freedom at 6 lumbar T12-S1 joints), seven rigid bodies (pelvis, thoracic, and five vertebrae), and 76 muscle fascicles. Moreover, the maximum velocity and acceleration of the thorax, lumbar, and pelvis, as well as their timing during the lifting activities were analyzed to investigate trunk kinematics. Results indicated that unstable, as compared to stable, lifting activities caused significantly larger peak L5-S1 (4677 N versus 4446 N, p = 0.021) and L4-L5 (4567 N versus 4366 N, p = 0.024) compressive loads in LBP individuals. Larger co-contraction of trunk muscles were found responsible for the larger compressive loads in LBP patients during unstable load lifting. The hand-load type (stable versus unstable) and group (LBP versus healthy) had no effects on kinematic variables and only the onset of peak kinematic parameters was significantly later in LBP patients. Slower movements with a change in movement strategy were observed in the LBP group. It was concluded that the nature of the external load adversely affected spinal loads in LBP patients thereby increasing the likelihood of further injury or pain.

Evaluation of Trunk Muscle Activation During the Two Directions of Flexi-Bar Exercise in People with and without Low Back Pain

Introduction: The flexible-bar with a small amplitude of 5 Hz, which transmits vibrations to the trunk, enables the activation of the core muscles that can be used to rehabilitate subjects with low back pain. Two types of exercise direction that can affect trunk muscles of low back pain subjects similar control group are not known. This study aimed to evaluate and compare exercises with two directions of the oscillating flexible poles in people with and without low back pain (LBP).&#x0D; Materials and Methods: Twelve women with Mean±SD age of 28.75±2.92 years, and body mass index (BMI) of 22.31±2.10 kg/m2 and a history of low back pain, and 12 healthy subjects with Mean±SD age of 28.75±2.49 years and BMI of 21.59±1.50 kg/m2 voluntarily participated in this study. The electromyography (EMG) signals of trunk muscles were measured during two handheld oscillating flexible bars in two directions. The root means square (RMS) of signals for each muscle is normalized by the maximum RMS.&#x0D; Results: The results of comparing two types of exercise in two groups showed significant differences for left external oblique (P=0.017), right external internal oblique (0.002), and left internal oblique (0.008). Also, the difference in the interaction between group×exercise was significant only for left internal oblique (P=0.026).&#x0D; Conclusion: Muscle activity in the low back pain group appears different while performing exercises with a flexible-bar compared to the control group. This confirms motor control impairment in these populations and having different strategies for trunk co-activation during exercise.

The effect of lumbopelvic region rotation relative flexibility on thorax–pelvis and pelvis–femur coordination during walking

BackgroundLumbopelvic region rotation relative flexibility (LRRF), which is defined as lumbopelvic region that is relatively less stiffness than the hip region, is associated with low back pain (LBP) symptoms. However, how LRRF is influenced by lumbopelvic region motion during walking is unclear. Research questionWhat is the influence of LBP and LRRF on coordination patterns of the thorax, pelvis, and femur during walking? MethodsThe presence of LRRF was determined based on whether the lumbopelvic rotation occurred in the first 50% of knee flexion or hip external rotation movement. Participants with LBP and LRRF were classified into the LBP group. Participants with LRRF but without LBP were classified into the early pelvis rotation (ROT) group, and those without LBP and relative flexibility were classified as controls. The thorax–pelvis coordination and pelvis–femur coordination during the stance cycles were calculated from the segmental angles obtained by three-dimensional motion analysis using a modified vector coding technique. ResultsIn the sagittal plane, the thorax–pelvis coordination of the LBP group showed more anti-phase patterns at both the early stance and midstance compared with controls and the ROT group. In the sagittal and horizontal planes, pelvis–femur coordination of the LBP and ROT groups showed more in-phase patterns during the early stance and midstance compared with controls. SignificanceRegardless of LBP, the presence of LRRF alters the intersegmental coordination during walking. In individuals with LRRF, stiffness of the hip may increase during walking. People who have LRRF without LBP may develop LBP in the future, and it is important for prevention to identify these differences in kinematics during walking.

Multifidus muscle cross-sectional area adaptations over two volleyball seasons and one off-season in athletes with and without low back pain.

The multifidus muscle is important in spine stabilization. Atrophy of the multifidus muscle has been associated with low back pain. To examine multifidus muscle cross-sectional area (CSA) adaptations over two volleyball seasons and one off-season in volleyball athletes experiencing low back pain or no low back pain. Twelve female NCAA division 1 volleyball athletes participated. Athletes were placed into a low back pain or no low back pain group. Athlete's multifidus was imaged and measured using ultrasound at four time points across seasons. Imaging time points were before season one, following season one, following off-season, and following season two. A single level mixed-model analysis of variance was used for all analyses. A Tukey HSD post hoc test was used to determine differences between and within the low back pain and the no low back pain groups. Following off-season training the pain group had clinically significant smaller multifidus CSA at the L4 (-2.36 cm2 difference or 17.5%) and L5 (-2.40 cm2 or 12.5%) levels. Non-significant (p> 0.05) decreases in multifidus CSA were seen in both groups following season one and two. Athletes with pain had decreased multifidus CSA at the L4 and L5 vertebral levels at all time points which was non-significant (p> 0.05). Clinically significant decreases in multifidus CSA occurred in female volleyball athletes with low back pain at the L4 and L5 level following off-season training. Volleyball athletes with pain had smaller multifidus CSA averages at all time points measured of the two year period.

Ankle reaction times with tray usage following a slip perturbation between subjects with and without chronic low back pain

BackgroundAbnormal stepping strategies have been associated with handheld tasks in subjects with chronic low back pain (LBP). However, the dominant ankle reactions of subjects with LBP remain unclear following a perturbation during handheld tasks. Research questionAre there differences in the reaction times of the ankle muscles during handheld tasks between subjects with and without LBP following a treadmill-induced slip perturbation? MethodsThirty-seven right limb dominant subjects with LBP and 37 subjects without LBP participated in the study. Each subject was introduced to a slip perturbation (1.37 m/sec velocity for 8.22 cm) with and without a handheld tray in random order. Subjects were allowed to recover by stepping forward for a 0.12 s duration while bilateral tibialis anterior (TA) and gastrocnemius (GA) muscle reaction times were measured by electromyography (EMG). ResultsThe EMG results indicated that the groups demonstrated significant interactions on the limb sides and muscles (F = 4.86, p = 0.03). The dominant TA reaction time was significantly faster in the LBP group (t = 2.14, p = 0.03) while holding a tray. SignificanceThe LBP group demonstrated faster reaction times on the dominant TA muscles during perturbations. Clinicians need to consider dominance-dependent compensatory ankle dorsiflexion strategies in LBP patients to help enhance dynamic balance and control.

Chronic non-specific low back pain and ankle proprioceptive acuity in community-dwelling older adults

BackgroundFor people above 65 years old, low-back pain (LBP) is associated with balance problems and falls. Down-weighting of proprioception due to ageing and LBP may cause such balance problems. While lumbar proprioceptive deficits have been shown in LBP and indications for more generalized deficits have been found, ankle proprioception, which is crucial for balance control, has not been studied in people with LBP. Research questionIs there any difference in ankle proprioceptive acuity between community-dwelling older adults with and without LBP? We hypothesized that ankle proprioception was impaired in community-dwelling older adults with LBP compared to those without LBP. MethodsThirty participants over 65 years old volunteered. Fifteen had LBP (M/F = 2/13, age = 72.0 (4.6) years), fifteen were healthy controls without back pain (control group) (M/F = 2/13, age = 72.1 (4.8) years). Ankle proprioception was measured in normal weight-bearing conditions, using the Active Movement Extent Discrimination Apparatus (AMEDA). Accuracy on the ankle proprioceptive test was expressed as absolute error (AE), constant error (CE) and variable error (VE). ResultsAE was significantly larger (P = 0.029, 95 % CI = [0.00, 0.90]) in the LBP group, CE was also significantly larger (P = 0.046, 95 % CI = [-0.91, −0.01]), indicating an underestimation of ankle inversion in participants with LBP compared to controls. VE was not different between the two groups (P = 0.520, 95 % CI = [-0.20, 0.59]). No significant correlation was found between pain intensity and AE, CE or VE (P > 0.05). ConclusionAnkle proprioception decreased in older people with LBP compared to healthy peers, suggesting impaired central proprioceptive processing. Older people with LBP underestimate the extent of ankle inversion, which may increase fall risk. Thus, evaluation and training of ankle proprioception may be useful in older people with LBP.