Gait adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing

Abstract

Patients with chronic non-specific low back pain (LBP) walk with more synchronous (in-phase) horizontal pelvis and thorax rotations than controls. Low thorax–pelvis relative phase in these patients appears to result from in-phase motion of the thorax with the legs, which was hypothesized to affect arm swing. In the present study, gait kinematics were compared between LBP patients with lumbar disc herniation and healthy controls during treadmill walking at different speeds and with different step lengths. Movements of legs, arms, and trunk were recorded. The patients walked with larger pelvis rotations than healthy controls, and with lower relative phase between pelvis and thorax horizontal rotations, specifically when taking large steps. They did so by rotating the thorax more in-phase with the pendular movements of the legs, thereby limiting the amplitudes of spine rotation. In the patients, arm swing was out-of phase with the leg, as in controls. Consequently, the phase relationship between thorax rotations and arm swing was altered in the patients.

Control of the lateral abdominal muscles during walking

“…The study was limited to young healthy women, whereas gender (Anders, Wagner, Puta, Grassme, & Scholle, 2009) as well as pathology (e.g., Huang et al, 2011) are known to affect gait.…”

Does experimentally induced stiffness of the spine make healthy subjects walk like low back pain patients?

“…Dynamic pedobarography finds its way into follow-up examinations of different feet pathologies. Recently, dynamic pedobarography was used to evaluate Ponseti treatment [1] and physical therapy [2] for talipes equinovarus, and there is only one study [3] of operated clubfeet. We wanted to know which pedobarographic differences there are between operated clubfeet and healthy feet and whether pedobarography could be used as a valuable measurement instrument for CF follow-up.…”

“…In healthy subjects, horizontal movements of pelvis and thorax start to go out of phase at such speeds, with the pelvis starting to move more with the legs and opposite to the thorax [2]. In low back pain, the pelvis still starts to move with the leg at higher speeds, but also the thorax does this, so that they move more in phase [1]. However, it is yet unknown how trunk coordination during gait in LBP is altered.…”

“…However, unlike in LBP patients (c.f. [1]), the decrease in relative phase was caused by a shift of both pelvis and thorax with respect to the leg. Moreover, unlike in LBP patients, the alterations in phase did reduce the spinal rotation amplitude.…”

“…Walking with low back pain is characterized by altered trunk coordination, especially at higher walking speeds [1]. In healthy subjects, horizontal movements of pelvis and thorax start to go out of phase at such speeds, with the pelvis starting to move more with the legs and opposite to the thorax [2].…”