Kinematic characterization of clinically observed aberrant movement patterns in patients with non-specific low back pain: a cross-sectional study

Abstract

BackgroundClinical observation of aberrant movement patterns during active forward bending is one criterion used to identify patients with non-specific low back pain suspected to have movement coordination impairment. The purpose of this study was to describe and quantify kinematic patterns of the pelvis and trunk using a dynamics systems approach, and determine agreement between clinical observation and kinematic classification.MethodNinety-eight subjects performed repeated forward bending with clinical observation and kinematic data simultaneously collected. Kinematic data were plotted using angle-angle, coupling-angle, and phase-plane diagrams. Accuracy statistics in conjunction with receiver operating characteristic curves were used to determine agreement between clinical observation and kinematic patterns.ResultsKinematic patterns were consistent with clinical observation and definitions of typical and aberrant movement patterns with moderate agreement (kappa = 0.46–0.50; PABAK = 0.49–0.73). Early pelvic motion dominance in lumbopelvic coupling-angle diagram ≥59° within the first 38% of the movement represent observed altered lumbopelvic rhythm. Frequent disruptions in lumbar spine velocity represented by phase-plane diagrams with local minimum occurrences ≥6 and sudden decoupling in lumbopelvic coupling-angle diagrams with sum of local minimum and maximum occurrences ≥15 represent observed judder.ConclusionThese findings further define observations of movement coordination between the pelvis and lumbar spine for the presence of altered lumbopelvic rhythm and judder. Movement quality of the lumbar spine segment is key to identifying judder. This information will help clinicians better understand and identify aberrant movement patterns in patients with non-specific low back pain.

Association between lumbopelvic motion and muscle activation in patients with non-specific low back pain during forward bending task: A cross-sectional study

“…Our motion results were consistent with several lumbar and pelvic motion studies in which they found similar changes in lumbar and pelvic contributions. [10][11][12][13][14] In addition, within-group comparisons suggested that patients with NSLBP obviously used pelvic dominate movement patterns, while healthy individuals used shared patterns between lumbar spine and pelvis during active forward bend. 14 To our knowledge, no study has investigated the relative velocity of the lumbar spine and pelvis during the active forward bend.…”

“…Related work has demonstrated kinematics in conjunction with a dynamic systems approach that could be used to quantify movement patterns that represent clinically observed aberrant movement patterns. 14 Electromyography (EMG) (TeleMyo 2400R G2, Noraxon Inc., Arizona, USA; common mode rejection ratio > 100 dB, input impedance > 100 MOhm, 500 gain) with pre-ampli¯ed bipolar electrodes (Kendall Medi-Trace 100, Kendall Inc.; Al/AgCl, disc-shaped, 1 cm diameter) was used to collect muscle activity from bilateral IO/TA, LM, ES, and GM. Skin was lightly abraded using abrasive paper and cleaned using cotton with alcohol to lower the skin impedance.…”

“…8,9 Current research studies have demonstrated that patients with NSLBP have altered lumbar and pelvic movement patterns including relative contribution and velocity during an active forward bend. [10][11][12][13][14] One systematic review indicated altered lumbar and pelvic contribution among patients with NSLBP during the active forward bend. 11 This systematic review also demonstrated consistent ndings for reduced lumbar velocity during this task.…”

Movement Control Impairment and Low Back Pain: State of the Art of Diagnostic Framing

“…Considering that tests for MCI evaluate the performance of certain motor tasks, the use and validation of motion capture tools seems to be the most appropriate strategy to make the evaluation as objective as possible. To date, only Wattananon et al [41] has tried to establish reference values for the interpretation of clinical trials through comparison between the observation of examiners and the digital data collected.…”

Comparison of effects of joint flexibility on the lumbo-pelvic rhythm in healthy university students while bending the trunk forward

“…Trunk flexion is an interaction between the intervertebral and pelvic joints (lumbo-pelvic rhythm), which is useful to understand spinal kinematics and motion 7,8) . During optimal trunk flexion, the hip joint contribute 65% to the movement [8][9][10][11] . The lumbar spine flexes before the hip joint when bending the trunk forward 7) .…”