Multi-segment spine range of motion in dancers with and without recent low back pain

BackgroundAltered spine kinematics are a common in people with LBP. This may be especially true for populations such as dancers, who are required to perform repetitive movements of the spine, although this remains unclear.Research questionDo dancers with recent LBP display altered spine kinematics compared to their asymptomatic counterparts?MethodsA cross-sectional study of multi-segment spine kinematics was performed. Forty-seven pre-professional and professional female dancers either with LBP in the past two months (n = 26) or no LBP in the past 12 months (n = 21) participated. Range of motion (ROM) during standing side bending, seated rotation, and walking gait were compared.ResultsFemale dancers with LBP displayed reduced upper lumbar transverse plane ROM in seated rotation (Effect Size (ES)= −0.61, 95% Confidence Interval (CI): −1.20, 0.02, p = 0.04), as well as reduced lower lumbar transverse plane ROM (ES=−0.65, 95% CI: −1.24, −0.06, p = 0.03) in gait. However, there was increased lower thoracic transverse plane ROM (ES = 0.62, 95% CI: 0.04, 1.21, p = 0.04) during gait. No differences in the frontal plane were observed.SignificanceAltered transverse plane spine kinematics were evident in dancers with recent LBP for select segments and tasks. This may reflect a protective movement strategy. However, as the effect sizes of observed differences were moderate, and the total number of differences between groups was small, collectively, it seems only subtle differences in spine kinematics differentiate dancers with LBP to dancers without.     

Lower extremity and spine characteristics in young dancers with and without patellofemoral pain

Very little is known about patellofemoral pain syndrome (PPFS) among young dancers. Understanding the mechanism of the injury and implementing a preventative programme are important in order to minimize the risk of PFPS. The aim of the current study is to determine the extent to which factors such as lower extremity and back characteristics are common among dancers with PFPS. The study population included 271 dancers with PFPS and 271 non-injured dancers, aged 10–16 years. All dancers were screened for morphometric profile, dance discipline (h/week), anatomical anomalies (present/absent of scoliosis, genu valgus/varum, etc.), and joint range of motion (measured by goniometer at the hip, knee, ankle, foot, and spinal joints). The predicting factors for PFPS among young dancers (10–11 years old) were: hyper hip abduction (OR = 0.906) and lower back and hamstring flexibility (OR = 3.542); for adolescent dancers (12–14 years old): hyper ankle dorsiflexion (OR = 0.888), hind foot-varum (OR = 0.260), and mobility of patella (OR = 2.666); and, for pre-mature dancers (15–16 years old): scoliosis (OR = 5.209), limited ankle plantar-flexion (OR = 1.060), and limited hip internal rotation (OR = 1.063). In conclusion, extrinsic and intrinsic parameters predisposing the dancers to knee injuries should be identified by screening in early stages of dance classes.     

Moving back: The radiation dose received from lumbar spine quantitative fluoroscopy compared to lumbar spine radiographs with suggestions for dose reduction

PurposeQuantitative fluoroscopy is an emerging technology for assessing continuous inter-vertebral motion in the lumbar spine, but information on radiation dose is not yet available. The purposes of this study were to compare the radiation dose from quantitative fluoroscopy of the lumbar spine with lumbar spine radiographs, and identify opportunities for dose reduction in quantitative fluoroscopy.MethodsInternationally reported dose area product (DAP) and effective dose data for lumbar spine radiographs were compared with the same for quantitative fluoroscopy and with data from a local hospital for functional radiographs (weight bearing AP, lateral, and/or flexion and extension) (n = 27). The effects of procedure time, age, weight, height and body mass index on the fluoroscopy dose were determined by multiple linear regression using SPSS v19 software (IBM Corp., Armonck, NY, USA).Results and conclusionThe effective dose (and therefore the estimated risk) for quantitative fluoroscopy is 0.561 mSv which is lower than in most published data for lumbar spine radiography.The dose area product (DAP) for sagittal (flexion + extension) quantitative fluoroscopy is 3.94 Gy cm² which is lower than local data for two view (flexion and extension) functional radiographs (4.25 Gy cm²), and combined coronal and sagittal dose from quantitative fluoroscopy (6.13 Gy cm²) is lower than for four view functional radiography (7.34 Gy cm²).Conversely DAP for coronal and sagittal quantitative fluoroscopy combined (6.13 Gy cm²) is higher than that published for both lumbar AP or lateral radiographs, with the exception of Nordic countries combined data.Weight, procedure time and age were independently positively associated with total dose, and height (after adjusting for weight) was negatively associated, thus as height increased, the DAP decreased.     

Lumbar spine MRI in the elite-level female gymnast with low back pain

Objective Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However, it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic athletes. Our hypothesis is that MRI will demonstrate the same types of abnormalities in both the symptomatic and asymptomatic gymnasts.Design Olympic-level female gymnasts received prospectively an MRI exam of the lumbar spine. Each of the gymnasts underwent a physical exam by a sports medicine physician just prior to the MRI for documentation of low back pain. Each MRI exam was evaluated for anterior apophyseal ring avulsion injury, compression deformity of the vertebral body, spondylolysis, spondylolisthesis, degenerative disease, focal disk protrusion/extrusion, muscle strain, epidural mass, and bone-marrow edema.Patients Nineteen Olympic-level female gymnasts (age 12–20 years) were evaluated prospectively in this study. All of these gymnasts were evaluated while attending a specific training camp.Results Anterior ring apophyseal injuries (9/19) and degenerative disk disease (12/19) were common. Spondylolysis (3/19) and spondylolisthesis (3/19) were found. Focal bone-marrow edema was found in both L3 pedicles in one gymnast. History and physical exam revealed four gymnasts with current low back pain at the time of imaging. There were findings confined to those athletes with current low back pain: spondylolisthesis, spondylolysis, bilateral pedicle bone-marrow edema, and muscle strain.Conclusions Our initial hypothesis was not confirmed, in that there were findings that were confined to the symptomatic group of elite-level female gymnasts.     

Inter-joint coordination and the flexion-relaxation phenomenon among adults with low back pain during bending

BackgroundAltered inter-joint coordination and reduced flexion-relaxation at end-range trunk flexion are common in people with low back pain. Inconsistencies in these behaviors, however, make assessment and treatment challenging for this population.Research questionThe study objective was to investigate patterns of regional lumbo-pelvic coordination and flexion-relaxation in adults with and without low back pain, during a bending task.MethodsAdults with low back pain (n = 16) and a healthy group (n = 21) performed three trials of a bending task. Motion capture and surface electromyography systems measured joint kinematics (hip, lower and upper lumbar spine) and muscle activity (erector spinae longissimus, iliocostalis, and multifidus). Continuous relative phase analysis determined inter-joint coordination of the hip/lower lumbar and lower lumbar/upper lumbar joint pairs, during flexion and extension periods. Flexion-relaxation ratios using normalized surface electromyography data determined the extent of flexion-relaxation for each muscle, during each period. For inter-joint coordination, two-way repeated measure mixed ANOVAs calculated the effects of group (healthy/low back pain), period, and their interactions. Separate hierarchical linear models were constructed and tested relationships between flexion-relaxation ratios and our independent variables, group and muscle, while controlling for patient characteristics.ResultsThe low back pain group had more out-of-phase coordination of the hip/lower lumbar joint pair compared to the healthy group (mean difference = 24.7°; 95 % confidence interval = 3.93–45.4), independent of movement period. No significant between group differences in lower lumbar/upper lumbar coordination were observed. The low back pain group demonstrated reduced flexion-relaxation of all muscles during full flexion (21.7 % reduction on average), with multifidus showing the least relaxation.SignificanceRegional differences in the lumbar spine and the possibility of subgroups with distinct movement pattern should be considered when analyzing coordination in people with low back pain. Multifidus showed the largest changes in flexion-relaxation and should be included when measuring this construct.     

Patients with chronic non-specific low back pain have altered movement coordination during functional reaching tasks

BackgroundIdentifying altered motor control patterns during functional movements in patients with chronic non-specific low back pain (LBP) has important clinical implications for reducing the risk of recurrence. While prior research has shown that magnitudes of lumbar and hip motion are not altered in patients with chronic non-specific LBP, it is possible that outcomes which describe coordination could provide greater discriminatory information between pathological and healthy movement.Research questionDetermine the effect of biological sex and chronic non-specific LBP on coordination between hip and lumbar motion during cyclic and discrete reaching.MethodsTwenty participants with chronic non-specific LBP (11 male/9 female, 23.5 ± 4.9 years old) and 21 control participants (12 male/9 female, 22.9 ± 6.1 years old) completed discrete and cyclic reaching tasks to a target in the mid-sagittal plane, while whole-body kinematics were collected using a three-dimensional motion capture system. Movement time, lumbar motion, hip motion, and the ratio between lumbar and hip motion were compared between participants with and without chronic non-specific LBP and between men and women using two-way mixed ANOVAs.ResultsParticipants with chronic non-specific LBP had reduced lumbar-hip ratios relative to control participants during both the cyclic (F = 4.779, p = 0.035, η² = 0.114) and discrete tasks (F = 4.743, p = 0.036, η² = 0.119), however group differences were not observed for hip or lumbar excursion during either task (p > 0.05). Participants with chronic non-specific LBP had slower reaching times relative to controls during the discrete reaching task (F = 4.795, p = 0.035, η² = 0.115). No significant effects of sex, and no interactions between group and sex were observed for any outcome.SignificanceReduced lumbar-hip ratios during reaching likely reflect a compensatory movement strategy that could play an important role in the development and progression of LBP.     

Chronic low back pain influences trunk neuromuscular control during unstable sitting among persons with lower-limb loss

BackgroundPersons with unilateral lower-limb loss are at increased risk for developing chronic low back pain. Aberrant trunk and pelvis motor behavior secondary to lower-limb loss potentially alters trunk postural control and increases demands on the trunk musculature for stability. However, it is unclear whether trunk postural control is associated with the presence or chronicity of low back pain within this population.Research questionIs there a potential role of impaired trunk postural control among persons with lower limb loss and chronic low back pain?MethodsTwo groups of males with unilateral lower-limb loss (n = 18 with chronic low back pain; n = 13 without pain) performed an unstable sitting task. Trunk postural control was characterized using traditional and non-linear measures derived from center-of-pressure time series, as well as trunk kinematics and the ratio of lumbar to thoracic erector spinae muscle activations.ResultsTraditional and non-linear center-of-pressure measures and trunk muscle activation ratios were similar between groups, while participants with chronic low back pain demonstrated greater trunk motion and reduced local dynamic stability.SignificanceOur results suggest that persons with both lower-limb loss and chronic low back pain exhibit impaired trunk postural control compared to those with limb loss but without pain. Aberrant trunk motor behavior may be a response to altered functional requirements of walking with a prosthesis. An inability to adequately control the trunk could lead to spinal instability and pain in the presence of repetitive exposure to aberrant motor behavior of these proximal structures during everyday activities.     

Postural balance impairment in Tunisian second division soccer players with groin pain: A case-control study

ObjectiveTo compare postural balance outcomes between soccer players with and without groin pain (GP).DesignCase-control study.SettingLaboratory.ParticipantsFifty-four soccer players, 27 with GP (GP group: GPG) and 27 healthy ones (control group: CG).Main outcome measuresStatic and dynamic postural balance were assessed with a force platform and Y-balance test (Y-BT), respectively. Hip abduction, internal rotation (IR), external rotation (ER) and total rotation (TR) of both limbs were evaluated.ResultsThe GPG exhibited significant higher centre of pressure values in the bipedal posture only on the foam surface in eyes opened and closed compared to controls. Besides, they had lower anterior, posteromedial and posterolateral reach distances and composite Y-BT score on the injured limb (IL) compared to non-injured limb (NIL) and dominant-limb (DL) of the CG. Moreover, they showed lower abduction, IR, ER, and TR on the IL compared to NIL and DL.ConclusionsDynamic unipedal postural balance disorder could be one of the limiting factors of performance in soccer players with non-time loss GP. Hence, postural balance data in these players could enable sport coaches and physical therapists to better understand the mechanisms contributing for performance decrease.     

Associations of self-report measures with gait,range of motion and proprioception in patients with lumbar spinal stenosis

IntroductionSpinal stenosis is defined as neurogenic claudication due to narrowing of the spinal canal lumen diameter. As the disease progresses, ambulation and gait may be impaired. Self-report measures are routinely used in the clinical setting to capture data related to lumbar pain symptoms, function and perceived disability. The associations between self-report measures and objective measures of physical function in patients with lumbar spinal stenosis are not well characterized. The purpose of this study was to determine the correlation between self-reported assessments of function with objective biomechanical measures of function.Methods25 subjects were enrolled in this study. Subjects completed self-report questionnaires and biomechanical assessments of gait analysis, lumbar 3D ROM and lumbar proprioception. Correlations were determined between self-report measures and biomechanical data.ResultsThe Oswestry Disability Index (ODI) was strongly correlated with stride length and gait velocity and weakly correlated with base of support. ODI was also weakly correlated with left lateral bending proprioception but not right lateral bending. The SF12 was not significantly correlated with any of the biomechanical measurements. Pain scores were weakly correlated with velocity, and base of support, and had no correlation any of the other biomechanical measures.DiscussionThere is a strong correlation between gait parameters and functional disability as measured with the ODI. Quantified gait analysis can be a useful tool to evaluate patients with lumbar spinal stenosis and to assess the outcomes of treatments on this group of patients.     

Functional differences in softball pitchers with and without upper extremity pain

ObjectivesThough pitchers often throw during multiple games in a day, there are currently no pitch count restrictions in softball. The accumulation of high pitch counts over time may contribute to the development of upper extremity pain. The purpose of our study was to examine functional characteristics of shoulder and hip range of motion (ROM), isometric strength (ISO), and ball speed in softball pitchers with and without upper extremity (UE) pain.DesignControlled laboratory design.MethodsFifty-three NCAA Division I softball pitchers (20.0 ± 1.4 years; 173.3 ± 8.3 cm; 80.9 ± 12.3 kg) participated and were divided into two groups: pain-free (n = 30) and pain in the UE (n = 23). Bilateral shoulder and hip external rotation (ER) and internal rotation (IR) ROM and ISO were measured prior to pitching to a catcher located 13.1 m (43 ft) away.ResultsIndependent samples t-tests revealed significantly greater throwing side (TS) hip ER ROM (p = 0.012), TS hip IR ISO (p = 0.038), glove side (GS) hip ER ISO (p = 0.025), TS shoulder ER ISO (p = 0.002), GS shoulder IR (p = 0.006) and ER (p = 0.004) ISO in the pain free group versus the UE pain group.ConclusionsDifferences in shoulder and hip ROM and ISO exist between those who have upper extremity pain and those who do not. Therefore, findings suggest that both the upper and lower extremities should be considered when treating softball pitchers with UE pain.     

Assessment instruments of movement quality in patients with non-specific low back pain: A systematic review and selection of instruments

BackgroundObserving and analyzing movement quality (MQ) in patients with non-specific low back pain (NS-LBP) is important in the clinical reasoning of primary care physiotherapists and exercise therapists. However, there is no standardized form of assessment. Research question: which MQ domains are measured with which instruments, and which activities are relevant, appropriate and methodologically sound for assessing MQ in patients with NS-LBP?MethodsThe study had three phases. In phase 1 we conducted a systematic review in PubMed, CINAHL and SPORTDiscus of literature published until October 2018. The selected studies measured MQ domains with instruments that enabled us to 1) compare MQ in self-paced dynamic activities of patients with NS-LBP and healthy controls, and/or 2) determine change over time of MQ in patients with NS-LBP. In phase 2 we established relevant dynamic activities to assess in patients with NS-LBP. In phase 3 we determined appropriateness and methodological qualities of the selected instruments.ResultsThirty cross-sectional and three pre-post-test studies were eligible. The instruments consisted of complex (n = 19) and simple (n = 7) instrumented motion analysis systems and standardized observational tests (n = 7). We identified three domains representative for MQ: range of motion (ROM), inter-segmental coordination, and whole-body movements. In these domains, patients with NS-LBP significantly differed from healthy controls, respectively 7/12, 12/13 and 13/20 studies. Moreover, ROM and whole-body movements significantly improved over time in patients with NS-LBP (3/3 studies). Based on phase 3, we concluded that none of the instruments are appropriate to assess MQ in patients with NS-LBP in primary care.SignificanceForward bending, lifting, and walking seem the most relevant activities to evaluate in patients with NS-LBP. However, we found no suitable instruments to measure ROM, inter-segmental coordination, or whole-body movements as determinants of MQ in these activities in daily practice. We therefore recommend such an instrument be developed.     

Relationship between radiographic abnormalities of lumbar spine and incidence of low back pain in high school rugby players: a prospective study

The purpose of this study was to examine the relationship between prevalent radiographic abnormalities of the lumbar spine and the incidence of low back pain in high school rugby players. Three hundred and twenty-seven incoming high school rugby players (15-16 years of age) were recruited between 1986 and 1994. All of them underwent athletic physical examination before participation in high school athletics. The relationship between prevalent radiographic abnormalities of the lumbar spine in the pre-participation athletic physical examination and the incidence of low back pain during a 1-year period after the start of participation in athletics was analyzed. Radiographic abnormalities assessed were spondylolysis, disc space narrowing, spinal instability, Schmorl's node, balloon disc, and spina bifida occulta. The frequency of respective radiographic abnormalities was 15.6%, 13.1%, 32.7%, 14.1%, 11.6%, and 30.6%. Two hundred and forty-three players (74.3%) had at least one of these radiographic abnormalities. The incidence of low back pain was 44.0% in players with no such radiographic abnormalities and 41.2% in those with at least one radiographic abnormality. The incidence of low back pain in players with the respective radiographic abnormalities was 72.5%, 46.5%, 46.7%, 39.1%, 34.2%, and 41.0%, and only players with spondylolysis had a significantly higher incidence of low back pain than those with no radiographic abnormalities. This study shows that a radiographic abnormality, specifically spondylolysis, is a significant radiological risk factor for low back pain in high school rugby players.     

Comparison of 3D spinal motions during stair-climbing between individuals with and without low back pain

In spite of the importance of stair-climbing (SC) as an activity of daily living, 3D spinal motion during SC has not been investigated in association with low back pain (LBP). The purpose of this research is to investigate the differences of the spinal motions during SC between an LBP group and a healthy control group, in order to provide insight into the LBP effect on the spinal motions. During two types of SC tests (single and double step SCs), we measured 3D angular motions (flexion/extension, lateral bending, and twist) of the pelvis, lumbar spine and thoracic spine using an inertial sensing-based, portable spinal motion measurement system. For the nine motion variables (i.e. three anatomical planes × three segments), range of motions (ROM) and movement patterns were compared to determine the differences between the two groups. It was found that the only variable having the p-value of a t-test lower than 0.05 was the flexion/extension of the lumbar spine in both SCs (i.e. the LBP group's ROM < the control group's ROM). Although the strength of this finding is limited due to the small number of subjects (i.e. 10 subjects for each group) and the small ROM differences between the groups, the comparison result of the t-test along with the motion pattern shows that the effect of LBP during SC may be localized to the lumbar spinal flexion/extension, making it an important measure to be considered in the rehabilitation and treatment of LBP patients.     

肌内效胶贴联合运动训练治疗慢性下腰痛的疗效

 目的 评价肌内效胶贴联合运动训练治疗慢性下腰痛的疗效。方法 某训练基地非特异性下腰痛患者113例, 按照就诊顺序分为肌内效胶贴组(A组, n=58)和肌内效胶贴联合训练组(B组, n=53), 于治疗1周后和4 周后分别应用视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(oswestry disability index, OSW)评价治疗效果。结果 B组治疗1和4 周后, VAS评分(5.05±1.98)分、OSW(64.73±7.92)分与治疗前相比明显改善, 差异有统计学意义(P<0.01)。A组治疗1周后, 疼痛症状和残疾指数较治疗前无明显改善, 治疗4周后明显好转。治疗后1周和4周B组的VAS 评分及OSW指数较A组明显下降, 差异有统计学意义(P<0.01)。结论 肌内效胶贴与运动训练联合应用能显著缓解慢性非特异性下腰痛的疼痛症状, 明显减轻残疾程度, 值得临床推广。
     

Musculoskeletal profile of the lumbar spine and hip regions in cricket fast bowlers

ObjectivesTo determine the career history of low back pain (LBP) in current elite female cricket fast bowlers and then compare measures of lumbar spine and hip range of motion (ROM) and trunk extensor endurance between those bowlers with and without a history of LBP. Measures for the female bowlers were also compared to a small sample of male fast bowlers.ParticipantsTwenty-six elite female fast bowlers and eight male fast bowlers of similar age and bowling experience.Main outcome measuresThe career history of LBP was determined by a self-administered questionnaire and by accessing medical records. Range of motion measures for the lumbar spine and hips were obtained using inclinometry or goniometry. Trunk extensor endurance was assessed using a modified Sorensen test.ResultsFourteen female fast bowlers had a history of LBP. There was a significant difference in lumbar lateral flexion ROM to the bowling arm side between those female fast bowlers with and without a history of LBP (p⩽0.05). The female fast bowlers had significantly more bilateral hip extension ROM (p⩽0.05) compared to the male fast bowlers.ConclusionsThis information should be useful for practitioners involved in the conditioning and rehabilitation of cricketers. Future prospective studies should investigate potential predictors of LBP in female fast bowlers.     

Relationship between radiographic abnormalities of lumbar spine and incidence of low back pain in high school and college football players: a prospective study

BACKGROUND: Low back pain is a common presenting symptom among players of American football. In Japan, however, skeletal disorders in football players, including low back problems, have been rarely studied, and management to prevent skeletal disorders has not been established. STUDY DESIGN: An epidemiological study with prospective observation. METHODS: The authors analyzed the relationship between lumbar spine abnormalities viewed through radiographs taken during the preparticipation physical examination, and the incidence of low back pain during a 1-year period in 171 high school and 742 college football players. Abnormalities assessed were spondylolysis, disc space narrowing, spinal instability, Schmorl's node, balloon disc, and spina bifida occulta. RESULTS: High school players with spondylolysis had a higher incidence of low back pain (79.8%) than those with no abnormal radiographic results (37.1%). College players with spondylolysis, disc space narrowing, and spinal instability had a higher incidence of low back pain (80.5%, 59.8%, and 53.5%, respectively) than those with no abnormal radiographs (32.1%), and college players with spondylolysis had a higher incidence of low back pain than those with disc space narrowing and spinal instability. CONCLUSIONS: The results of the present study suggest that an abnormality such as spondylolysis is the most significant risk factor for low back pain in high school and college football players, and that disc space narrowing and spinal instability are also significant risk factors for low back pain in athletes with greater athletic activity such as college football players.     

Shoulder strength and range of motion in elite female cricket fast bowlers with and without a history of shoulder pain

This study aimed to determine the prevalence of shoulder pain in female cricket fast bowlers and compare the shoulder rotation range of motion and strength of those bowlers with and without a history of shoulder pain. The active range of motion and isokinetic strength of the shoulder internal and external rotators was assessed in the bowling and non-bowling shoulders of 26 elite Australian female fast bowlers. Twelve bowlers had a history of shoulder pain. There were significant bilateral differences in external rotation range of motion for those bowlers without a history of shoulder pain (p < 0.05), and in internal rotation range of motion for both the total cohort and those bowlers with a history of shoulder pain (p < 0.05). There were no bilateral differences in average torques or average torque ratios, nor were there any differences in rotation range of motion, torques or torque ratios in the bowling shoulder between bowlers with and without a history of shoulder pain. There was an association between concentric internal rotation torque for the bowling shoulder and years of fast bowling (r_s = 0.45). Given the relatively small number of elite female cricketers, future research in this field will need to recruit fast bowlers from other cricket playing nations to increase the power of studies and provide more confidence in the statistical outcomes.     

Relationship between low back pain, disability, MR imaging findings and health care provider

Objective To determine the association between the self-report of pain and disability and findings on lumbar MR images, and to compare two different health care providers in Spanish patients with low back pain (LBP).Design Cross-sectionalMaterial and methods A total of 278 patients, 137 men and 141 women aged 44±14 years submitted with low back pain (LBP) were studied. One hundred and nine patients were from the National Health System (NHS) and 169 from private practice. Patients with previous discitis, surgery, neoplasm or traumatic episodes were excluded. Every patient completed a disability questionnaire with six core items, providing a score of disability from 2 to 28. All patients had sagittal spin-echo T1 and turbo spin-echo T2, axial proton-density and MR myelography weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30.Results Patients with a combination of LBP and sciatica showed the highest levels of disability (p=0.002). MR imaging scores only correlated with pain interference with normal work (p=0.04), but not with other disability questions. Patients from the NHS showed greater disability scores than private ones (p=0.001) and higher MR imaging scores (p=0.01).Conclusion In patients with LBP, MR imaging only correlates with pain interference with work but not with other disability questions. Differences are found between private and NHS patients, the latter being more physically affected.This work was presented as a scientific exhibit at the European Congress of Radiology, 7-11 March 2003, Vienna, Austria.     

Foot kinematics and leg muscle activation patterns are altered in those with limited ankle dorsiflexion range of motion during incline walking

BackgroundLarger ankle dorsiflexion (DF) is required when walking on inclined surfaces. Individuals with limited DF range of motion (ROM) may experience greater tissue stress on sloped surfaces and walk in altered gait patterns compared to the those with normal DF ROM.Research questionWould the individuals with limited DF ROM walk with distinctive ankle DF patterns compared to those with normal DF ROM on the inclined surfaces?MethodsTen Limited DF ROM (passive ROM=35.3 ± 2.7°) and nine Normal DF ROM (passive ROM=46.4 ± 4.2°) participants walked on a treadmill at five slope angles (0°, 5°, 10°, 15°, 20°) for 2 min at a self-selected speed. The peak DF angles and the peak myoelectric activity levels of the tibialis anterior (TA) and soleus (SOL) muscles were quantified during the swing and stance phases of each walking trial, and they were compared between the two groups.ResultsParticipants with limited DF ROM walked with smaller peak DF (3.1° at 0° slope ~ 8.4° at 20° slope) and greater peak TA activity in swing than those of the Normal ROM participants (3.4° ~ 12.2°), with significant differences at 20° slope. The peak DF angle in stance (Limited: 9.6° ~ 19.0°; Normal: 10.1° ~ 21.0°) did not differ between the two groups at all slopes, but the peak activity of the SOL muscle was significantly greater for the Limited group at slopes of 10° and higher.SignificanceStudy results indicate that incline walking could be more challenging to the individuals with limited DF ROM as they need to approach and push-off the sloped surfaces with more efforts of the dorsiflexor and the plantar flexor muscles, respectively. Prolonged walking on inclined surfaces may produce faster development of muscle fatigue or tissue damage than those with normal DF ROM.     

Acute effects of anesthetic lumbar spine injections on temporal spatial parameters of gait in individuals with chronic low back pain: A pilot study

This study examined whether epidural injection-induced anesthesia acutely and positively affected temporal spatial parameters of gait in patients with chronic low back pain (LBP) due to lumbar spinal stenosis. Twenty-five patients (61.7 ± 13.6 years) who were obtaining lumbar epidural injections for stenosis-related LBP participated. Oswestry Disability Index (ODI) scores, Medical Outcomes Short Form (SF-36) scores, 11-point Numerical pain rating (NRS_pain) scores, and temporal spatial parameters of walking gait were obtained prior to, and 11-point Numerical pain rating (NRS_pain) scores, and temporal spatial parameters of walking gait were obtained after the injection. Gait parameters were measured using an instrumented gait mat. Patients received transforaminal epidural injections in the L1-S1 vertebral range (1% lidocaine, corticosteroid) under fluoroscopic guidance. Patients with post-injection NRS_pain ratings of “0” or values greater than “0” were stratified into two groups: 1) full pain relief, or 2) partial pain relief, respectively. Post-injection, 48% (N = 12) of patients reported full pain relief. ODI scores were higher in patients with full pain relief (55.3 ± 21.4 versus 33.7 12.8; p = 0.008). Post-injection, stride length and step length variability were significantly improved in the patients with full pain relief compared to those with partial pain relief. Effect sizes between full and partial pain relief for walking velocity, step length, swing time, stride and step length variability were medium to large (Cohen’s d > 0.50). Patients with LBP can gain immediate gait improvements from complete pain relief from transforaminal epidural anesthetic injections for LBP, which could translate to better stability and lower fall risk.