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Background: Individuals experiencing age-related decline in locomotor functions are at high-risk of developing locomotive syndrome (LS). LS requires long-term care and greatly influences the quality of life and activities of daily living. The LS risk test was established as a diagnostic criterion by the Japanese Orthopedic Association. Although the relationship between the test and motor function has been established, few studies have reported on the characteristics of LS kinematically and kinetically.Research Question: Do elderly with LS show different kinetic and kinematic characteristics compared with healthy elderly during static standing and level walking?Methods: Forty-four Participants were divided into an LS group and a non-LS group based on the scores of the LS risk test. The standing posture and walking of the participants were measured using a three-dimensional motion capture system. The results of the groups were compared using an unpaired t-test, and then the characteristics of the LS group were extracted using logistic regression analysis.Results: LS group exhibited trunk flexion during both standing and gait. A higher intervertebral disc compressive force, which is the index of the low-back mechanical stress, during standing and an increase in ankle plantarflexion angle during walking were observed in LS group.Significance: This study determined the kinematic and kinetic features of elderly with LS. The findings suggest that parameters related to the trunk and ankle could be associated with LS. Further studying the characteristics of LS in older adults via motion analysis can help develop prevention and intervention methods for LS. [ABSTRACT FROM AUTHOR]

Background: Although poor standing posture is a known cause of low back pain, the mechanisms involved are unclear. The aim of this study was to clarify the kinetic and posture angle features of standing posture that might influence low back pain. Methods: Sixty-seven young men were enrolled in this cross-sectional case-control study and were categorized according to whether they did or did not have low back pain. Habitual standing posture was assessed in each group, using a three-dimensional motion analysis system, force plates, and a spinal mouse. Kinetic and posture angle factors were compared between participants with and without low back pain. The relationship between specific features of standing posture and low back pain was analyzed using logistic regression. Results: The intervertebral disc compressive force and the low back moment were significantly greater in the group with low back pain than in the group without low back pain. The intervertebral disc compressive force was the factor most strongly associated with low back pain during static standing. Conclusions: Logistic regression analysis identified intervertebral disc compressive force as an independent variable associated with low back pain. This finding suggests that increased intervertebral disc compressive force may promote development of low back pain in standing posture. [ABSTRACT FROM AUTHOR]

Lumbar spinal stenosis causes cauda equina and nerve root compression, resulting in neurological symptoms. Although trunk flexion during level walking may alleviate these symptoms by enabling spinal canal decompression, some patients do not use this strategy. We aimed to identify the kinetic and kinematic variables that affect trunk flexion in patients during level walking. Gait was recorded in 111 patients using a three-dimensional motion capture system and six force plates. From the data recorded, walking velocity, bilateral step length, cycle time, maximum trunk flexion angle, forward pelvic tilt angle, pelvic rotation angle, maximum and minimum joint angles, and moment and power of the lower limb were calculated. Then a step-wise multiple regression analysis was conducted to identify kinetic and kinematic variables affecting trunk flexion. The maximum hip extension angle (β = 0.416), maximum hip flexion moment (β = -0.348), and step length (β = 0.257) were identified as variables significantly affecting the trunk flexion angle. The coefficient of determination adjusted for the degree of freedom was 0.294 (p < 0.05). Our results suggest that patients with lumbar spinal stenosis choose one of two strategies to alleviate symptoms during walking. One strategy is gait with trunk flexion posture to increase step length and hip extension angle. The other strategy is gait with trunk upright posture to decrease step length and hip extension angle. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether a trunk orthosis with joints providing resistive force (TORF) modifies sagittal malalignment during level walking in patients with lumbar spinal stenosis (LSS). Fifteen patients, 6 months after undergoing surgery for LSS, performed level walking at a self-selected speed while wearing a TORF. Dynamic sagittal alignment, including sagittal vertical axis, lumbar lordosis, and pelvic tilt, and spatiotemporal data as well as lower limb kinematic and kinetic data were recorded using a three-dimensional motion analysis system and six force plates. Statistical analysis was performed to compare these data with and without the TORF, respectively. Compared to the condition without the TORF, the use of the TORF significantly decreased positive sagittal vertical axis (p < 0.05) and increased the lumbar lordosis and pelvic tilt (p < 0.05). Peak hip flexion angle and extension moment during loading response (LR) significantly increased (p < 0.05), and peak hip extension angle and flexion moment during PS statistically decreased (p < 0.05). There was no difference in spatiotemporal data between the two conditions. Our findings suggest that TORF may modify the dynamic sagittal global alignment and lower limb kinematic and kinetics in postoperative LSS patients during level walking. [ABSTRACT FROM AUTHOR]

Late braking force (LBF) is often observed in the late stance phase of the paretic lower limb of stroke patients. Nevertheless, the effects and association of LBF remain unclear. We examined the kinetic and kinematic parameters associated with LBF and its effect on walking. Herein, 157 stroke patients were enrolled. Participants walked at a comfortable speed selected by them, and their movements were measured using a 3D motion analysis system. The effect of LBF was analyzed as a linear relationship with spatiotemporal parameters. Multiple linear regression analyses were performed with LBF as the dependent variable and kinetic and kinematic parameters as independent variables. LBF was observed in 110 patients. LBF was associated with decreased knee joint flexion angles during the pre-swing and swing phases. In the multivariate analysis, trailing limb angle, cooperativity between the paretic shank and foot, and cooperativity between the paretic and non-paretic thighs were related to LBF (p < 0.01; adjusted R2 = 0.64). LBF in the late stance phase of the paretic lower limb reduced gait performance in the pre-swing and swing phases. LBF was associated with trailing limb angle in the late stance, coordination between the paretic shank and foot in the pre-swing phase, and coordination between both thighs. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to construct a 3D dynamic model to quantify low back load during single person dependent transfer, and to compare the effects of wearing style of a low back belt on low back loading. Of the nine subjects participating in this study, eight adopted the role of caregiver and one was a simulated patient. Tasks were general transfer without either subject wearing a low back belt (WB), transfer with the patient wearing a low back belt (BP), transfer with both subjects wearing low back belts (BB), and transfer with the caregiver wearing a low back belt (BC). Low back lateral and extension moments in BB and BC transfers showed the significantly smaller values than those in WB transfers (p <0.01). The results suggest that the wearing of a low back belt by caregivers would reduce low back joint moment during transfers. [Copyright &y& Elsevier]

Increased propulsion force (PF) in the paretic limb is associated with improved walking speed in patients with stroke. However, late braking force (LBF), an additional braking force occurring between PF onset and toe-off, is present in a subset of stroke patients. Few studies have investigated the changes in LBF and walking speed in these patients. This study aimed to elucidate the patterns of change in PF and LBF during fast gait in hemiplegics and identify potential compensatory strategies based on the LBF patterns. Data from 100 patients with stroke walking at both comfortable (mean, 0.79 ± 024 m/s) and fast speeds (mean, 1.06 ± 0.35 m/s) were analyzed retrospectively stroke using a 3D motion analyzer. PF was higher during fast-speed walking than that during comfortable-speed walking in all patients, while LBF showed both decreasing and increasing trends during fast-speed walking. In the LBF increasing pattern, a reduction in in-phase coordination of the shank and foot during the pre-swing phase was observed, along with an increase in pelvic hike during fast-speed walking compared to those in the decreasing LBF pattern. Our findings demonstrate that alterations in LBF patterns are associated with gait deviations in patients with stroke at fast speeds. [ABSTRACT FROM AUTHOR]

Background Patients with diabetes often develop diabetic peripheral neuropathy, which is a distal symmetric polyneuropathy, so foot function on the non-amputated side is expected to affect gait in vascular trans-tibial amputees. However, there is little information on the kinematics and kinetics of gait or the effects of diabetic peripheral neuropathy in vascular trans-tibial amputees. This study aimed to clarify these effects, including the biomechanics of the ankle on the non-amputated side. Methods Participants were 10 vascular trans-tibial amputees with diabetic peripheral neuropathy (group V) and 8 traumatic trans-tibial amputees (group T). Each subject's gait was analyzed at a self-selected speed using a three-dimensional motion analyzer and force plates. Findings Ankle plantarflexion angle, heel elevation angle, and peak and impulse of anterior ground reaction force were smaller on the non-amputated side during pre-swing in group V than in group T. Center of gravity during pre-swing on the non-amputated side was lower in group V than in group T. Hip extension torque during loading response on the prosthetic side was greater in group V than in group T. Interpretation These findings suggest that the biomechanical function of the ankle on the non-amputated side during pre-swing is poorer in vascular trans-tibial amputees with DPN than in traumatic trans-tibial amputees; the height of the center of gravity could not be maintained during this phase in vascular trans-tibial amputees with diabetic peripheral neuropathy. The hip joint on the prosthetic side compensated for this diminished function at the ankle during loading response. [ABSTRACT FROM AUTHOR]

Depression is a relevant risk factor for low back pain and is associated with the outcomes of low back pain. Depression also often overlaps with somatisation. As previous studies have suggested that somatisation or a higher somatic symptom burden has a role in the outcomes of low back pain, the aim of the present cross-sectional study was to examine whether somatic symptom burden was associated with health-related quality of life in individuals with chronic low back pain independent of depression. We analyzed internet survey data on physical and mental health in Japanese adults aged 20–64 years with chronic low back pain (n = 3,100). Health-related quality of life was assessed using the EuroQol five dimensions (EQ-5D) questionnaire. Somatic symptom burden and depression were assessed using the Somatic Symptom Scale-8 (SSS-8) and the Patient Health Questionnaire-2 (PHQ-2), respectively. SSS-8 score was categorized as no to minimal (0–3), low (4–7), medium (8–11), high (12–15), and very high (16–32). The association between SSS-8 and EQ-5D was examined using linear regression models, adjusting for depression and other covariates, including age, sex, BMI, smoking, marital status, education, exercise, employment, and the number of comorbid diseases. A higher somatic symptom burden was significantly associated with a lower health-related quality of life independent of depression and the number of comorbid diseases (regression coefficient = 0.040 for SSS-8 high vs. very high and 0.218 for non to minimal vs. very high, p trend <0.0001). In conclusion, somatic symptom burden might be important for the health-related quality of life of individuals with chronic low back pain. [ABSTRACT FROM AUTHOR]

Background: Knee pain is common and related to knee osteoarthritis. However, there is a discrepancy between knee pain and radiographic osteoarthritis. In the general population, knee pain is associated with psychological and cognitive factors, which would be one explanation for the discrepancy. Limited evidence demonstrates that somatization is associated with knee pain. This study examined the association between disability due to knee pain and a high somatising tendency.Methods: Japanese adults (aged 20-64 years) who had experienced knee pain in the past four weeks were included in this study (n = 14,695, 50% women). Data were extracted from a large internet survey. Somatising tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). Disability due to knee pain was categorized into three levels: 1) knee pain without difficulty with activities of daily living (ADL), 2) knee pain with ADL difficulty but without requiring sick leave, and 3) knee pain requiring sick leave. The association between ≥ high somatising tendency (SSS-8 score ≥ 12) as well as very high somatising tendency (SSS-8 score ≥ 16) and disability due to knee pain was examined using logistic regression models adjusted for age, sex, body mass index, depressive symptoms, education level, regular exercise, chronicity of knee pain (≥3 months), osteoarthritis, rheumatoid arthritis, and fibromyalgia.Results: Greater disability due to knee pain was associated with a higher odds ratio for ≥ high somatising tendency (adjusted odds ratio (aOR) = 2.36 [2.10-2.66] in group 2 vs. group 1, aOR = 3.23 [2.66-3.92] in group 3 vs. group 1). Stronger associations were found for a very high somatising tendency (aOR = 2.80 [2.42-3.23] in group 2 vs. group 1, aOR = 4.51 [3.64-5.58] in group 3 vs. group 1).Conclusions: Somatization may play a role in disability due to knee pain in the general adult population with knee pain, similar to the role of somatization in low back pain. [ABSTRACT FROM AUTHOR]

STUDY DESIGN.: Biomechanical study using a 3D motion analysis system conducted in a laboratory setting. OBJECTIVE.: To determine the effect of mental processing on low back load during lifting. SUMMARY OF BACKGROUND DATA.: In addition to ergonomic factors such as frequent lifting, work-related psychosocial factors are significant in the onset of disabling back pain. Although the ergonomic effects on low back load while lifting have been investigated and are widely accepted in the workplace, few studies have investigated the effect of psychosocial factors on low back load while lifting. METHODS.: Thirteen healthy subjects lifted a box from the ground in 4 different lifting tasks in randomized order: (1) squat posture with knees flexed; (2) stoop posture with knees extended; (3) squat posture with mental processing using arithmetic tasks; and (4) stoop posture with mental processing using arithmetic tasks. We used a 3D motion analysis system and 4 force plates to record kinematic and kinetic data. We calculated dynamic triaxial low back joint moments and low back compression force as index parameters of low back load under these experimental conditions. RESULTS.: Mental processing significantly increased peak low back compression force and low back extension moment, but not lateral flexion or rotation moment, while lifting in both lifting postures. Also, mental processing increased trunk bending angles in the squat posture. Although a tendency for decreased pelvic forward tilt was observed, mental processing did not significantly decrease forward pelvic tilt in the stoop posture. CONCLUSION.: Mental processing during lifting tasks seems to affect both trunk and pelvis angles in the sagittal plane for squat and stoop postures, resulting in increased low back load. The present findings might help explain the effect of ergonomic demands of lifting tasks as well as psychosocial factors responsible for the onset of disabling back pain.Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

Background: Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers. Method: This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain. Results: Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003–6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819–9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067–6.224). Conclusions: Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain. [ABSTRACT FROM AUTHOR]

Purpose: Spinal fusion surgery is often performed with pelvic fixation to prevent distal junctional kyphosis. The inclusion of spinopelvic fixation has been reported to induce progression of hip joint arthropathy in a radiographic follow-up study. However, its biomechanical mechanism has not yet been elucidated. This study aimed to compare the changes in hip joint moment before and after spinal fusion surgery. Methods: This study was an observational study and included nine patients (eight women and one man) who were scheduled to undergo spinopelvic fusion surgery. We calculated the three-dimensional external joint moments of the hip during gait, standing, and climbing stairs before and 1 year after surgery. Results: During gait, the maximum extension moment was 0.51 ± 0.29 and 0.63 ± 0.40 before and after spinopelvic fusion surgery (p = 0.011), and maximum abduction moment was 0.60 ± 0.33 and 0.83 ± 0.34 before and after surgery (p = 0.004), respectively. During standing, maximum extension moment was 0.76 ± 0.32 and 1.04 ± 0.21 before and after spinopelvic fusion surgery (p = 0.0026), and maximum abduction moment was 0.12 ± 0.20 and 0.36 ± 0.22 before and after surgery (p = 0.0005), respectively. During climbing stairs, maximum extension moment was − 0.31 ± 0.30 and − 0.48 ± 0.15 before and after spinopelvic fusion surgery (p = 0.040), and maximum abduction moment was 0.023 ± 0.18 and − 0.02 ± 0.13 before and after surgery (p = 0.038), respectively. Conclusion: This study revealed that hip joint flexion–extension and abduction–adduction moments increased after spinopelvic fixation surgery in the postures of standing, walking, and climbing stairs. The mechanism was considered to be adjacent joint disease after spinopelvic fusion surgery including sacroiliac joint fixation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the association between body mass index and chronic pain.Methods: The outcome was chronic pain prevalence by body mass index (BMI). BMIs of less than 18.5, 18.5-25.0, 25.0-30.0, and 30.0 or over kg/m2 were defined as underweight, normal weight, overweight, and obese.Subjects: We used data from 4993 participants (2464 men and 2529 women aged 20-79 years) of the Pain Associated Cross-sectional Epidemiological survey in Japan. Sex-stratified multivariable-adjusted odds ratios were calculated with 95% confidence intervals using a logistic regression model including age, smoking, exercise, sleep time, monthly household expenditure, and presence of severe depression. We analyzed all ages and age subgroups, 20-49 and 50-79 years.Results: The prevalence of chronic pain was higher among underweight, overweight, and obese male respondents than those reporting normal weight, with multivariable odds ratios of 1.52 (1.03-2.25), 1.55 (1.26-1.91), and 1.71 (1.12-2.60). According to underweight, only older men showed higher prevalence of chronic pain than normal weight men with odd ratios, 2.19 (1.14-4.20). Being overweight and obese were also associated with chronic pain in women; multivariable odds ratios were 1.48 (1.14-1.93) and 2.09 (1.20-3.64). Being underweight was not associated with chronic pain.Conclusion: There was a U-shaped association between BMI and chronic pain prevalence among men ≥ 50 years, and a dose-response association among women. Our finding suggests that underweight should be considered in older men suffering chronic pain. [ABSTRACT FROM AUTHOR]

Purposes: To evaluate the usefulness of our original five questions in a medical interview for diagnosing discogenic low back pain (LBP), and to establish a support tool for diagnosing discogenic LBP. Materials and Methods: The degenerative disc disease (DDD) group (n = 42) comprised patients diagnosed with discogenic LBP associated with DDD, on the basis of magnetic resonance imaging findings and response to analgesic discography (discoblock). The control group (n = 30) comprised patients with LBP due to a reason other than DDD. We selected patients from those who had been diagnosed with lumbar spinal stenosis and had undergone decompression surgery without fusion. Of them, those whose postoperative LBP was significantly decreased were included in the control group. We asked patients in both groups whether they experienced LBP after sitting too long, while standing after sitting too long, squirming in a chair after sitting too long, while washing one’s face, and in the standing position with flexion. We analyzed the usefulness of our five questions for diagnosing discogenic LBP, and performed receiver operating characteristic (ROC) curve analysis to develop a diagnostic support tool. Results: There were no significant differences in baseline characteristics, except age, between the groups. There were significant differences between the groups for all five questions. In the age-adjusted analyses, the odds ratios of LBP after sitting too long, while standing after sitting too long, squirming in a chair after sitting too long, while washing one’s face, and in standing position with flexion were 10.5, 8.5, 4.0, 10.8, and 11.8, respectively. The integer scores were 11, 9, 4, 11, and 12, respectively, and the sum of the points of the five scores ranged from 0 to 47. Results of the ROC analysis were as follows: cut-off value, 31 points; area under the curve, 0.92302; sensitivity, 100%; and specificity, 71.4%. Conclusions: All five questions were useful for diagnosing discogenic LBP. We established the scoring system as a support tool for diagnosing discogenic LBP. [ABSTRACT FROM AUTHOR]

Thalamic pain is a central neuropathic pain disorder which occurs after stroke. Its severe chronic pain is often intractable to pharmacotherapies and affects the patients’ activities of daily living (ADL) and quality of life (QOL). Recently, spinal cord stimulation (SCS) has been reported to be effective in relieving the pain of thalamic pain; however, the effect of SCS on gait performance in patients is unknown. Therefore, we evaluated the gait performance before and after SCS in a case with thalamic pain. A 73-year-old male with thalamic pain participated in this study. We evaluated the gait of the patient two times: before SCS insertion and after 6 days of SCS. At the second evaluation, we measured the gait in three conditions: stimulation off, comfortable stimulation, and strong stimulation. SCS succeeded in improving the pain from 7 to 2 on an 11-point numerical rating scale. Step frequency and the velocity of gait tended to increase between pre- and poststimulation periods. There were no apparent differences in gait among the three stimulation conditions (off, comfortable, and strong) at the poststimulation period. SCS may be effective on gait in patients with thalamic pain. [ABSTRACT FROM AUTHOR]