Lumbar and thoracic kinematics during step‐up: Comparison of three‐dimensional angles between patients with chronic low back pain and asymptomatic individuals

Abstract

While alterations in spinal kinematics have been repeatedly observed in chronic low back pain (CLBP) patients, their exact nature is still unknown. Specifically, there is a need for comprehensive assessments of multi-segment spinal angles during daily-life activities. The purpose of this exploratory study was to characterize three-dimensional angles at the lower lumbar, upper lumbar, lower thoracic and upper thoracic joints in CLBP patients and asymptomatic controls during stepping up with three different step heights. Spinal angles of 10 patients with non-specific CLBP (6 males; 38.7±7.2 years old; 22.3±1.6 kg/m 2 ) and 11 asymptomatic individuals (6 males; 36.7±5.4 years old; 22.9±3.8 kg/m 2 ) were measured in a laboratory using a camera-based motion capture system. Seven out of the 12 angle curves had characteristic patterns, leading to the identification of 20 characteristic peaks. Comparing peak amplitudes between groups revealed statistically significantly smaller sagittal-and frontal-plane angles in the patient group at the upper lumbar joint with the two higher steps and at the lower lumbar joint with the higher step. Significantly reduced angles were also observed in sagittal-plane at the upper thoracic joint with the two smaller steps. Moreover, a higher number of significant differences between groups was detected with the two higher steps than with the smallest step. In conclusion, this study showed the value of a comprehensive description of spinal angles during step-up tasks and provided insights into the alterations with CLBP. These preliminary results support prior research suggesting that CLBP rehabilitation should facilitate larger amplitudes of motion during functional activities.

Patients With Chronic Low Back Pain Have an Individual Movement Signature: A Comparison of Angular Amplitude, Angular Velocity and Muscle Activity Across Multiple Functional Tasks

“…Overall, based on the present findings and previous reports (Shum et al, 2005;Laird et al, 2014;Christe et al, 2016bChriste et al, , 2020Papi et al, 2018;Moissenet et al, 2021), reduced lumbar amplitude and angular velocity seems to be key characteristics of patients with CLBP. Furthermore, the consistent reduced sagittal-plane lumbar angular amplitude and velocity across all the functional tasks suggest that these spinal movement alterations generalize across a wide range of daily-life activities.…”

“…Participants then performed one submaximal voluntary contraction in crook lying as described by Dankaerts et al (2004). Reflective markers were then attached to the participants lumbar region and pelvis following a previously described protocol (Seay et al, 2008;Christe et al, 2016bChriste et al, , 2017Christe et al, , 2020. Lumbar markers were placed on the spinous processes of L1, L3 and L5 with four additional markers attached between these markers on each side of the spine, at a distance of 5 cm.…”

“…Spinal kinematics were calculated based on a three-segment biomechanical model that includes the pelvis and the lower lumbar and upper lumbar spine (Christe et al, 2016b(Christe et al, , 2017(Christe et al, , 2020. Briefly, markers' trajectories were used to calculate the orientation of anatomical frames embedded in each segment.…”

“…In order to extract the movement measures from the angular amplitude, angular velocity and muscle activity curves, first, the curves were time-normalized to 0-100% for each repetition of each task. The beginning and the end of the task were determined visually using strict criteria based on markers displacements (Christe et al, 2016b(Christe et al, , 2020. Then, following the methodology in prior studies (Christe et al, 2016b(Christe et al, , 2017(Christe et al, , 2020, the curves were tested using the coefficient of multiple correlation (CMC) (Kadaba et al, 1989) and the curves presenting a characteristic pattern were described by discrete measures.…”

“…The beginning and the end of the task were determined visually using strict criteria based on markers displacements (Christe et al, 2016b(Christe et al, , 2020. Then, following the methodology in prior studies (Christe et al, 2016b(Christe et al, , 2017(Christe et al, , 2020, the curves were tested using the coefficient of multiple correlation (CMC) (Kadaba et al, 1989) and the curves presenting a characteristic pattern were described by discrete measures. In total, 12 measures were identified.…”