Lumbopelvic Movement Patterns Research Articles

Relationship between onset of trunk muscle activities and pelvic kinematics in individuals with and without chronic low back pain.

Lumbopelvic movement patterns during prone hip extension has been proposed as a clinical screening method for trunk muscle dysfunction in patients with chronic low back pain (CLBP). However, correlations between trunk muscle onset and pelvic kinematics have not been investigated. To examine the correlation between trunk muscle onset and pelvic kinematics during prone hip extension in participants with CLBP. Fifteen patients with CLBP and 15 healthy individuals participated. We evaluated the muscle activities of the lumbar multifidus, the longissimus, and the semitendinosus via electromyogram and the displacement angles of the pelvic tilt, oblique and rotation. The onset of the multifidus at the ipsilateral side of hip extension was significantly delayed in the patients with CLBP compared to the control group (P< 0.001). The onset of the ipsilateral multifidus in the control group was significantly correlated with increased anterior pelvic tilt angle (P= 0.019, r= 0.597), whereas no significant correlation was observed in the CLBP group (P= 0.810, r=-0.068). The results suggest that pelvic kinematics during prone hip extension does not predict the delayed trunk muscle onset in patients with CLBP.

Lumbopelvic movement coordination during walking improves with transfemoral bone anchored limbs: Implications for low back pain

BackgroundLow back pain (LBP) is more prevalent in patients with transfemoral amputation using socket prostheses than able-bodied individuals, in part due to altered spinal loading caused by aberrant lumbopelvic movement patterns. Early evidence surrounding bone-anchored limb functional outcomes is promising, yet it remains unknown if this novel prosthesis influences LBP or movement patterns known to increase its risk. Research questionHow are self-reported measures of LBP and lumbopelvic movement coordination patterns altered when using a unilateral transfemoral bone-anchored limb compared to a socket prosthesis? MethodsFourteen patients with unilateral transfemoral amputation scheduled to undergo intramedullary hardware implantation for bone-anchored limbs due to failed socket use were enrolled in this longitudinal observational cohort study (7 F/7 M, Age: 50.2±12.0 years). The modified Oswestry Disability Index (mODI) (self-reported questionnaire) and whole-body motion capture during overground walking were collected before (with socket prosthesis) and 12-months following bone-anchored limb implantation. Lumbopelvic total range of motion (ROM) and continuous relative phase (CRP) segment angles were calculated during 10 bilateral gait cycles. mODI, total ROM, CRP and CRP variabilities were compared between time points. ResultsmODI scores were significantly reduced 12-months after intramedullary hardware implantation for the bone-anchored limb (P = 0.013). Sagittal plane trunk and pelvis total ROM during gait were reduced after implantation (P = 0.001 and P < 0.001, respectively). CRP values were increased (more anti-phase) in the sagittal plane during single limb stance and reduced (more in-phase) in the transverse plane during pre-swing of the amputated limb gait cycle (P << 0.001 and P = 0.029, respectively). No differences in CRP values were found in the frontal plane. SignificanceDecreases in mODI scores and lumbopelvic ROM, paired with the changes in lumbopelvic coordination, indicate that bone-anchored limbs may reduce LBP symptoms and reduce compensatory movement patterns for people with unilateral transfemoral amputation.

Biomechanical compensations during a stand-to-sit maneuver using transfemoral osseointegrated prostheses: A case series

BackgroundPatients with transfemoral amputation and socket prostheses are at a heightened risk of developing musculoskeletal overuse injuries, commonly due to altered joint biomechanics. Osseointegrated prostheses, which involve direct anchorage of the prosthesis to the residual limb through a bone anchored prosthesis, are a novel alternative to sockets yet their biomechanical effect is largely unknown. MethodsFour patients scheduled to undergo unilateral transfemoral prosthesis osseointegration completed two data collections (baseline with socket prosthesis and 12-months after prosthesis osseointegration) in which whole-body kinematics and ground reaction forces were collected during stand-to-sit tasks. Trunk, pelvis, and hip kinematics, and the surrounding muscle forces, were calculated using subject-specific musculoskeletal models developed in OpenSim. Peak joint angles and muscle forces were compared between timepoints using Cohen's d effect sizes. FindingsCompared to baseline with socket prostheses, patients with osseointegrated prostheses demonstrated reduced lateral trunk bending (d = 1.46), pelvic obliquity (d = 1.09), and rotation (d = 1.77) toward the amputated limb during the stand to sit task. This was accompanied by increased amputated limb hip flexor, abductor, and rotator muscle forces (d> > 0.8). InterpretationImproved lumbopelvic movement patterns and stabilizing muscle forces when using an osseointegrated prosthesis indicate that this novel prosthesis type likely reduces the risk of the development and/or progression of overuse injuries, such as low back pain and osteoarthritis. We attribute the increased muscle hip muscle forces to the increased load transmission between the osseointegrated prosthesis and residual limb, which allows a greater eccentric ability of the amputated limb to control lowering during the stand-to-sit task.

Recovery of the lumbopelvic movement and muscle recruitment patterns using motor control exercise program in people with chronic nonspecific low back pain: A prospective study.

This study aims to investigate the dysfunction and recovery of the lumbopelvic movement and motor control of people with chronic nonspecific low back pain after a structured rehabilitation which emphasizes on re-education and training of movement and motor control. The lumbopelvic movement and motor control pattern of 30 adults (15 with chronic low back pain, 15 healthy controls) were assessed using 3D motion and electromyographic analysis during the repeated forward bending test, in additional to the clinical outcome measures. Regional kinematics and muscle recruitment pattern of the symptomatic group was analysed before and after the 6-week rehabilitation, and compared to healthy controls. Significant improvement in back pain, functional capacity and self-efficacy of the symptomatic group was found after the rehabilitation. Patients with chronic nonspecific low back pain were capable to recover to a comparable level of the healthy controls in terms of their lumbopelvic movement and motor control pattern upon completion of a 6-week rehabilitation program, despite their dysfunction displayed at baseline. Phase specific motor control reorganization in which more profound and positive changes shown during the flexion phase. Our findings indicate that the recovery of the movement and motor control pattern in patients with chronic low back pain achieved to a comparable level of the healthy able-bodies. The improvement of both the physical outcome measures suggest that specific rehabilitation program which emphasizes on optimizing motor control during movements would help promoting the functional recovery of this specific low back pain subgroup.

The effects of bending speed on the lumbo-pelvic kinematics and movement pattern during forward bending in people with and without low back pain

BackgroundImpaired lumbo-pelvic movement in people with low back pain during bending task has been reported previously. However, the regional mobility and the pattern of the lumbo-pelvic movement were found to vary across studies. The inconsistency of the findings may partly be related to variations in the speed at which the task was executed. This study examined the effects of bending speeds on the kinematics and the coordination lumbo-pelvic movement during forward bending, and to compare the performance of individuals with and without low back pain.MethodsThe angular displacement, velocity and acceleration of the lumbo-pelvic movement during the repeated forward bending executed at five selected speeds were acquired using the three dimensional motion tracking system in seventeen males with low back pain and eighteen males who were asymptomatic. The regional kinematics and the degree of coordination of the lumbo-pelvic movement during bending was compared and analysed between two groups.ResultsSignificantly compromised performance in velocity and acceleration of the lumbar spine and hip joint during bending task at various speed levels was shown in back pain group (p < 0.01). Both groups displayed a high degree of coordination of the lumbo-pelvic displacement during forward bending executed across the five levels of speed examined. Significant between-group difference was revealed in the coordination of the lumbo-pelvic velocity and acceleration (p < 0.01). Asymptomatic group moved with a progressively higher degree of lumbo-pelvic coordination for velocity and acceleration while the back pain group adopted a uniform lumbo-pelvic pattern across all the speed levels examined.ConclusionsThe present findings show that bending speed imposes different levels of demand on the kinematics and pattern of the lumbo-pelvic movement. The ability to regulate the lumbo-pelvic movement pattern during the bending task that executed at various speed levels was shown only in pain-free individuals but not in those with low back pain. Individuals with low back pain moved with a stereotyped strategy at their lumbar spine and hip joints. This specific aberrant lumbo-pelvic movement pattern may have a crucial role in the maintenance of the chronicity in back pain.

Lumbar lordosis in prone position and prone hip extension test: comparison between subjects with and without low back pain

BackgroundProne hip extension (PHE) is a common and widely accepted test used for assessment of the lumbo-pelvic movement pattern. Considerable increased in lumbar lordosis during this test has been considered as impairment of movement patterns in lumbo-pelvic region. The purpose of this study was to investigate the change of lumbar lordosis in PHE test in subjects with and without low back pain (LBP).MethodA two-way mixed design with repeated measurements was used to investigate the lumbar lordosis changes during PHE in two groups of subjects with and without LBP. An equal number of subjects (N = 30) were allocated to each group. A standard flexible ruler was used to measure the size of lumbar lordosis in prone-relaxed position and PHE test in each group.ResultThe result of two-way mixed-design analysis of variance revealed significant health status by position interaction effect for lumbar lordosis (P < 0.001). The main effect of test position on lumbar lordosis was statistically significant (P < 0.001). The lumbar lordosis was significantly greater in the PHE compared to prone-relaxed position in both subjects with and without LBP. The amount of difference in positions was statistically significant between two groups (P < 0.001) and greater change in lumbar lordosis was found in the healthy group compared to the subjects with LBP.ConclusionsGreater change in lumbar lordosis during this test may be due to more stiffness in lumbopelvic muscles in the individuals with LBP.

KINEMATIC DIFFERENCES IN LUMBOPELVIC AND HIP MOVEMENT PATTERNS DURING A LOWER LIMB MOVEMENT TEST BETWEEN TWO GROUPS OF PEOPLE WITH LOW BACK PAIN

Increased lumbopelvic motion during limb movements’ tests was reported in low back pain (LBP) patients with and without rotational demand activities. The aim of this study was to compare lumbopelvic movement pattern between two groups of LBP patients with and without rotational demand activity during active hip external rotation test. A total of 39 patients with non-specific chronic LBP participated in this study. Patients were allocated into two groups, in first group 15 subjects (mean [Formula: see text] years) with rotational demand activities such as tennis, squash and golf, and in second group 24 subjects (mean [Formula: see text]) without rotational demand activities participated in current study. Kinematic data from lumbopelvic-hip region during active hip external rotation test (AHER) were collected by a 3D motion analysis system. Variables including range of motion (ROM) of hip external rotation, pelvic rotation, pelvic rotation during first half of hip rotation motion and timing of pelvic-hip movement were calculated by MATLAB software for both sides and after this, independent t-test was used to compare the variables between two groups of study. The mean lumbopelvic rotation in lower extremities tests for both sides and lumbopelvic rotation in the dominant limb external rotation test in the patients with rotational demand activities were significantly more than other group ([Formula: see text]). During dominant lower limb movement test, pelvic rotation in first half of movement and in patients with rotational activities was greater than in non-rotational group but hip rotation was statistically lesser than other group ([Formula: see text]). Other variables between the two groups were not significantly different ([Formula: see text]). The result of the study suggest that LBP patients who have rotational demand sports activities may move their lumbopelvic region in a greater magnitude during the AHER test than LBP people without rotational demand activities. Therefore, Lumbopelvic movement pattern in different groups of patients with LBP and based on their specific activities is different with each other.

Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing

An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain (LBP) during prolonged standing. We examined asymmetry of lumbopelvic movement timing during a clinical test of active hip abduction in back-healthy people who developed LBP symptoms during standing (Pain Developers; PDs) compared to back-healthy people who did not develop LBP symptoms during standing (Non Pain Developers, NPDs). Participants completed the hip abduction test while movement was recorded with a motion capture system. Difference in time between start of hip and lumbopelvic movement was calculated (startdiff). PDs moved the lumbopelvic region earlier during left hip abduction than right hip abduction. There was no difference between sides in NPDs. In PDs, the amount of asymmetry was related to average symptom intensity during standing. Asymmetric lumbopelvic movement patterns may be a risk factor for LBP development during prolonged standing.

How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain?

BackgroundComparing movements/postures in people with and without lower back pain (LBP) may assist identifying LBP-specific dysfunction and its relationship to pain or activity limitation. This study compared the consistency in lumbo-pelvic posture and movement (range and pattern) in people with and without chronic LBP (>12 week’s duration).MethodsWireless, wearable, inertial measurement units measured lumbar lordosis angle, range of movement (ROM) and lumbo-pelvic rhythm in adults (n = 63). Measurements were taken on three separate occasions: two tests on the same day with different raters and a third (intra-rater) test one to two weeks later. Participants performed five repetitions of tested postures or movements. Test data were captured automatically. Minimal detectable change scores (MDC90) provided estimates of between-test consistency.ResultsThere was no significant difference between participants with and without LBP for lordosis angle. There were significant differences for pelvic flexion ROM (LBP 60.8°, NoLBP 54.8°, F(1,63) = 4.31, p = 0.04), lumbar right lateral flexion ROM (LBP 22.2°, NoLBP 24.6° F(1,63) = 4.48, p = .04), trunk right lateral flexion ROM (LBP 28.4°, NoLBP 31.7°, F(1,63) = 5.9, p = .02) and lumbar contribution to lumbo-pelvic rhythm in the LBP group (LBP 45.8 %, F(1,63) = 4.20, NoLBP 51.3 % p = .044). MDC90 estimates for intra and inter-rater comparisons were 10°–15° for lumbar lordosis, and 5°–15° for most ROM. For lumbo-pelvic rhythm, we found 8–15 % variation in lumbar contribution to flexion and lateral flexion and 36–56 % variation in extension. Good to excellent agreement (reliability) was seen between raters (mean r = .88, ICC (2,2)).ConclusionComparisons of ROM between people with and without LBP showed few differences between groups, with reduced relative lumbar contribution to trunk flexion. There was no difference between groups for lordosis. Wide, within-group differences were seen for both groups for ROM and lordosis. Due to variability between test occasions, changes would need to exceed 10°–15° for lumbar lordosis, 5°–15° for ROM components, and 8–15 % of lumbar contribution to lumbo-pelvic rhythm, to have 90 % confidence that movements had actually changed. Lordosis, range of movement and lumbo-pelvic rhythm typically demonstrate variability between same-day and different-day tests. This variability needs to be considered when interpreting posture and movement changes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1250-1) contains supplementary material, which is available to authorized users.

Correlation of physical activity, active range of motion and type of ADL-task with lumbo-pelvic movement pattern

Correlation of physical activity, active range of motion and type of ADL-task with lumbo-pelvic movement pattern

Lumbopelvic flexibility modulates neuromuscular responses during trunk flexion–extension

Various stimuli such as the flexibility of lumbopelvic structures influence the neuromuscular responses of the trunk musculature, leading to different load sharing strategies and reflex muscle responses from the afferents of lumbopelvic mechanoreceptors. This link between flexibility and neuromuscular response has been poorly studied.The aim of this study was to investigate the relationship between lumbopelvic flexibility and neuromuscular responses of the erector spinae, hamstring and abdominal muscles during trunk flexion–extension. Lumbopelvic movement patterns were measured in 29 healthy women, who were separated into two groups according to their flexibility during trunk flexion–extension. The electromyographic responses of erector spinae, rectus abdominis and biceps femoris were also recorded.Subjects with greater lumbar flexibility had significantly less pelvic flexibility and vice versa. Subjects with greater pelvic flexibility had a higher rate of relaxation and lower levels of hamstring activation during maximal trunk flexion.The neuromuscular response patterns of the hamstrings seem partially modulated by pelvic flexibility. Not so with the lumbar erector spinae and lumbar flexibility, despite the assertions of some previous studies. The results of this study improve our knowledge of the relationships between trunk joint flexibility and neuromuscular responses, a relationship which may play a role in low back pain.

Change in lumbar lordosis during prone lying knee flexion test in subjects with and without low back pain.

BackgroundProne lying knee flexion (PLKF) is one of the clinical tests used for assessment of the lumbo-pelvic movement pattern. Considerable increase in lumbar lordosis during this test has been considered as impairment of movement patterns in lumbar-pelvic region. However, no study has directly evaluated the change in lordosis during active PLKF test in subjects with low back pain (LBP). The purpose of this study was to investigate the change of lumbar lordosis in PLKF test in subjects with and without LBP.MethodsA convenience sample of 80 subjects participated in the study. Subjects were categorized into two groups: those with chronic non-specific LBP (N = 40, mean age: 40.84 ± 17.59) and with no history of LBP (N = 40, mean age: 23.57 ± 10.61). Lumbar lordosis was measured with flexible ruler, first in prone position and then on active PKF test in both subjects with and without LBP. Data was analyzed by using statistical methods such as, independent t-test and paired t-test.ResultsThere were statistically significant differences in lumbar lordosis between prone position and after active PLKF in both subjects with and without LBP (P < 0.0001). The amount of change in lordosis during PLKF test was not significant between the two groups (P = 0.65). However these changes were greater among patients with LBP.ConclusionIncrease in lumbar lordosis during this test may be due to excessive flexibility of movement of the lumbar spine in the direction of extension and abnormal movement patterns in the individuals with LBP.

Lumbopelvic Movement Pattern Differences in Two Groups of Low Back Pain Subjects with and without Rotational Activities during Active Hip External Rotation Test

Introduction: The aim of this study was to compare the lumbopelvic movement pattern between two groups of low back pain patients with and without rotational demand activity during active hip external rotation test. Materials and methods: Thirty nine male subjects with non-specific chronic low back pain were participated in this study. They were included fifteen subjects (mean age=31.5 years) with rotational demand activities such as tennis, squash and twenty four subjects (mean age=31.2 years) without rotational demand activities. Kinematic data from lumbopelvic-hip region during active hip external rotation test was collected by 3-D motion analysis system. Variables including ROM of hip external rotation, lower extremity external rotation, pelvic rotation, and pelvic rotation during first half of hip rotation and timing of pelvic and hip movement were calculated by MATHLAB and after this; independent T-test was used to compare the same variables between two groups of study. Results: Lumbopelvic rotation in individuals with rotational demand activity was significantly more than other group (p=0/03). But other variables between two groups were not prominently different (p>0/05). Conclusion: Lumbopelvic movement pattern in subjects with low back pain is mainly different in comparison with other group. Key words: Low back pain, lumbopelvic motion, task specific, movement impairment, hip external rotation

Effects of Tensor Fasciae Latae-Iliotibial Band Self-Stretching on Lumbopelvic Movement Patterns During Active Prone Hip Lateral Rotation in Subjects With Lumbar Extension Rotation Syndrome

The purpose of this study was to identify the effects of tensor fasciae latae-iliotibial band (TFL-ITB) self-stretching exercise on the lumbopelvic movement patterns during active prone hip lateral rotation (HLR) in subjects with lumbar extension rotation syndrome accompanying TFL-ITB shortness. Eleven subjects (9 male and 2 female) were recruited for the two-week study. A three dimensional ultrasonic motion analysis system was used to measure the lumbopelvic movement patterns. The TFL-ITB length was measured using the modified Ober`s test and was expressed as the hip horizontal adduction angle. The subjects were instructed how to perform TFL-ITB self-stretching exercise program at home. A paired t-test was performed to determine the significant difference in the angle of lumbopelvic rotation, movement onset time of lumbopelvic rotation, TFL-ITB length, and LBP intensity before and after the two-week period of performing the TFL-ITB self-stretching exercise. The results showed that after the intervention, the lumbopelvic rotation angle decreased significantly (p<.05), the movement onset time reduced significantly (p<.05), and LBP intensity decreased slightly but not significantly (p=.07). The hip horizontal adduction angle increased significantly (p<.05) after the intervention. These findings indicate that TFL-ITB stretching exercise increased TFL-ITB length, decreased lumbopelvic rotation angle, and delayed the movement onset time of lumbopelvic rotation after two-weeks. In conclusion, the TFL-ITB self-stretching exercise performed over a period of two weeks may be an effective approach for patients with lumbar extension rotation syndrome accompanying TFL-ITB shortness.

Sex Differences in Lumbopelvic Movement Patterns During Hip Medial Rotation in People With Chronic Low Back Pain

Hoffman SL, Johnson MB, Zou D, Van Dillen LR. Sex differences in lumbopelvic movement patterns during hip medial rotation in people with chronic low back pain. Objective To examine sex differences in lumbopelvic motion and symptom behavior during hip medial rotation in people with low back pain (LBP). We hypothesized that men would demonstrate greater and earlier lumbopelvic motion and would be more likely to report increased symptoms compared with women. Design Cross-sectional observational study. Setting University musculoskeletal analysis laboratory. Participants Persons with chronic LBP (N=59; 30 men, 29 women) were recruited from the community and a university-based physical therapy clinic. Interventions Not applicable. Main Outcome Measures Lumbopelvic rotation range of motion, amount of hip rotation completed before the start of lumbopelvic motion, and provocation of LBP symptoms during the test of prone hip medial rotation were measured. Results Men demonstrated significantly more lumbopelvic rotation (men, 10.0°±5.1°; women, 4.5°±3.9°; P<.001) and completed less hip rotation before the start of lumbopelvic motion (men, 5.4°±3.8°; women, 16.0°±13.2°; P<.001) compared with women. Additionally, a significantly greater percentage of men (60.0%) than women (34.5%; P=.050) reported increased symptoms with hip medial rotation. Conclusions Men could be at greater risk than women for experiencing LBP symptoms related to hip medial rotation as a result of greater and earlier lumbopelvic motion.

Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain

Increased and early lumbopelvic motion during trunk and limb movements is thought to contribute to low back pain (LBP). Therefore, reducing lumbopelvic motion could be an important component of physical therapy treatment. Our purpose was to examine the effects of classification-specific physical therapy treatment (Specific) based on the Movement System Impairment (MSI) model and non-specific treatment (Non-Specific) on lumbopelvic movement patterns during hip rotation in people with chronic LBP. We hypothesized that following treatment people in the Specific group would display decreased lumbopelvic rotation and achieve more hip rotation before lumbopelvic rotation began. We hypothesized that people in the Non-Specific group would display no change in these variables. Kinematic data collected before and after treatment for hip lateral and medial rotation in prone were analyzed. The Specific group ( N = 16) demonstrated significantly decreased lumbopelvic rotation and achieved greater hip rotation before the onset of lumbopelvic rotation after treatment with both hip lateral and medial rotation. The Non-Specific group ( N = 16) demonstrated significantly increased lumbopelvic rotation and no change in hip rotation achieved before the onset of lumbopelvic rotation. People who received treatment specific to their MSI LBP classification displayed decreased and later lumbopelvic motion with hip rotation, whereas people who received generalized non-specific treatment did not.