Mechanical and neuromuscular changes with lateral trunk lean gait modifications

Robbins, Shawn M.; Teoli, Anthony; Preuss, Richard

doi:10.1016/j.gaitpost.2016.07.017

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…Among kinematic compensatory responses to vGRI reduction, specifically, trunk angle was of particular interest given prior indications of acute onset of low back pain during biofeedback, 9,13 and the potential for longer term injury. 18 No significant relationship between trunk angle and target reduction was observed in this study, though marginal increases in the base of support were observed. However, in offloading the targeted limb, compensatory kinetic changes were observed contralaterally; specifically, a tendency toward a larger first peak in vGRF.…”

Section: Discussioncontrasting

confidence: 58%

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Modulation of Vertical Ground Reaction Impulse With Real-Time Biofeedback: A Feasibility Study

Golyski

Bell

Husson

et al. 2018

Journal of Applied Biomechanics

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Given its apparent representation of cumulative (vs peak) loads, this feasibility study investigates vertical ground reaction impulse (vGRI) as a real-time biofeedback variable for gait training aimed at reducing lower limb loading. Fifteen uninjured participants (mean age = 27 y) completed 12 2-min trials, 1 at each combination of 4 walking speeds (1.0, 1.2, 1.4, and 1.6 m/s) and 3 targeted reductions in vGRI (5, 10, and 15%) of the assigned ("target") limb, with the latter specified relative to an initial baseline (no feedback) condition at each speed. The ability to achieve targeted reductions was assessed using step-by-step errors between measured and targeted vGRI. Mean (SD) errors were 5.2% (3.7%); these were larger with faster walking speeds but consistent across reduction targets. Secondarily, we evaluated the strategy used to modulate reductions (ie, stance time or peak vertical ground reaction force [vGRF]) and the resultant influences on knee joint loading (external knee adduction moment [EKAM]). On the targeted limb, stance times decreased (P < .001) with increasing reduction target; first and second peaks in vGRF were similar (P > .104) across all target conditions. While these alterations did not significantly reduce EKAM on the target limb, future work in patients with knee pathologies is warranted.

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Section: Discussioncontrasting

confidence: 58%

“…Of note is that overall compensatory strategies were of interest because unintended biomechanical consequences have been exhibited in previous biofeedback studies, specifically the onset of acute low back pain 9,13 and potential for long term injury. 18…”

mentioning

confidence: 99%

Modulation of Vertical Ground Reaction Impulse With Real-Time Biofeedback: A Feasibility Study

Golyski

Bell

Husson

et al. 2018

Journal of Applied Biomechanics

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“…This may cause proximal gait adaptations, such as lateral trunk leaning , possibly to avoid pain and minimize knee stress through decrease in the external knee adduction moment . Increased trunk leaning demands trunk muscle contraction, resulting in muscle soreness and fatigue, as illustrated by increased electromyographic activity in the erector spinae after lateral trunk leaning . These alterations in trunk muscle activity may induce and aggravate LBP since relatively low sustained trunk muscle activation may cause muscle fatigue .…”

Section: Discussionmentioning

confidence: 99%

“…Altered lower extremity kinematics in patients with knee OA may cause compensatory trunk motions, such as lateral trunk leaning , possibly due to efforts made to avoid pain and minimize knee stress . The compensatory trunk motion demands more trunk muscle contraction , which may initiate or aggravate LBP. However, limited research is available on the biomechanical mechanisms that link knee kinematics to LBP ; so we must further understand the interaction between knee kinematics and LBP.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Varus Thrust During Gait and Low Back Pain in Individuals With Knee Osteoarthritis

Iijima

Suzuki

Aoyama

et al. 2020

Arthritis Care & Research

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Objective To test the hypothesis that varus thrust visualized during gait is associated with a higher prevalence of low back pain (LBP) in individuals with knee osteoarthritis (OA). Methods Individuals with knee OA (Kellgren/Lawrence grade ≥1) underwent a gait observation to assess varus thrust. The participants identified LBP and its severity using questionnaires. Logistic regression analyses were performed to examine the association between varus thrust and LBP. Results We included 205 participants (mean age 68.19 years; 72.20% women). A total of 45 participants (22.0%) showed varus thrust in their painful knee, in whom 31 (68.89%) and 18 (40.00%) were identified as having any LBP and moderate‐to‐severe LBP (numerical rating scale ≥4 points), respectively. Patients with varus thrust demonstrated a 3.6‐fold higher risk of the presence of moderate‐to‐severe LBP (95% confidence interval [95% CI] 1.62–8.10). In patients with LBP, the presence of varus thrust was associated with more severe LBP intensity (proportional odds ratio 2.25 [95% CI 1.02–4.96]). Conclusion This study highlights the novel relationship between varus thrust and LBP, which supports the idea of a biomechanical link, the so‐called knee–spine syndrome. These findings provide new insight for clarifying the pathogenesis of LBP related to knee OA.

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“…Lumbar load during gait is usually analysed by muscle activity measured using electromyography. Various studies report that increased trunk sway increases the stress on lumbar muscles during gait [18][19][20][21]. However, action potential obtained from electromyography correlates with muscle force only in isometric contractions, but not in concentric and eccentric contractions.…”

Section: Introductionmentioning

confidence: 99%

Effect of Unilateral Knee Extension Restriction on the Lumbar Region during Gait

Nakatsuji

Kawada

Takeshita

et al. 2022

Journal of Healthcare Engineering

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Unilateral knee extension restriction might change trunk alignment and increase mechanical load on the lumbar region during walking. We aimed to clarify lumbar region mechanical load during walking with restricted knee extension using a musculoskeletal model simulation. Seventeen healthy adult males were enrolled in this study. Participants walked 10 m at a comfortable velocity with and without restricted right knee extension of 15° and 30° using a knee brace. L4–5 joint moment, joint reaction force, and muscle forces around the lumbar region during walking were calculated for each condition. Peaks of kinetic data were compared among three gait conditions during 0%–30% and 50%–80% of the right gait cycle. Lumbar extension moment at early stance of the bilateral lower limbs was significantly increased in the 30° restricted condition ( p ≤ 0.021 ). Muscle force of the multifidus showed peaks at stance phase of the contralateral side during walking, and the erector spinae showed force peaks at early stance of the bilateral lower limb. Muscle force of the multifidus and erector spinae increased with increasing degree of knee flexion ( p ≤ 0.010 ), with a large eﬀect size (η2 = 0.273–0.486). The joint force acting on L4–5 showed two peaks at early stance of the bilateral lower limbs during the walking cycle. The anterior and vertical joint force on L4–5 increased by 14.2%–36.5% and 10.0%–23.0% in walking with restricted knee extension, respectively ( p ≤ 0.010 ), with a large effect size (η2 = 0.149–0.425). Restricted knee joint extension changed trunk alignment and increased the muscle force and the vertical and anterior joint force on the L4–5 joint during walking; this tendency became more obvious with increased restriction angle. Our results provide important information for therapists engaged in the rehabilitation of patients with knee contracture.

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Mechanical and neuromuscular changes with lateral trunk lean gait modifications

Cited by 5 publications

References 27 publications

Modulation of Vertical Ground Reaction Impulse With Real-Time Biofeedback: A Feasibility Study

Modulation of Vertical Ground Reaction Impulse With Real-Time Biofeedback: A Feasibility Study

Relationship Between Varus Thrust During Gait and Low Back Pain in Individuals With Knee Osteoarthritis

Effect of Unilateral Knee Extension Restriction on the Lumbar Region during Gait

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