Search

Purpose: A multidimensional classification approach suggests that motor control impairment subgroups exist in non-specific chronic low back pain (NSCLBP). Differences in sitting lumbar posture have been identified between two such subgroups [flexion pattern (FP) and active extension pattern (AEP)] and healthy individuals; however, functional spinal movement has not been explored. This study will evaluate whether NSCLBP subgroups exhibit regional spinal kinematic differences, compared to healthy individuals, during functional tasks., Methods: Observational, cross-sectional study design. Spinal kinematics of 50 NSCLBP subjects (27 FP, 23 AEP) and 28 healthy individuals were investigated using 3D motion analysis (Vicon™) during functional tasks [reaching upwards, step down, step up, lifting, and replacing a box, stand-to-sit, sit-to-stand, bending to retrieve (and returning from retrieving) a pen from the floor]. Mean sagittal angle for the total thoracic, total lumbar, upper thoracic, lower thoracic, upper lumbar, and lower lumbar regions between groups was compared., Results: Significant differences were observed in lower thoracic and upper lumbar regions between NSCLBP subgroups during most tasks. Significant differences were observed between the FP and healthy group in the lower thoracic region during stand-to-sit-to-stand tasks and bending (and returning from) to retrieve a pen from the floor. All significant results demonstrated the FP group to operate in comparatively greater flexion., Conclusions: The thoraco-lumbar spine discriminated between FP and AEP, and FP and healthy groups during functional tasks. FP individuals demonstrated more kyphotic thoraco-lumbar postures, which may be pain provocative. No significant differences were observed between AEP and healthy groups, suggesting that alternative mechanisms may occur in AEP.

Postural re-education is an integral part of physiotherapy management in patients with back pain. Although the link between posture and back pain is largely unknown, postural re-education is performed on the premise of optimizing spinal alignment to minimize stresses on the passive structures of the spine, to facilitate optimal muscular support and thus to prevent possible damage and further pain. A reliable and clinically meaningful measurement of spinal postures to monitor such interventions remains challenging. This study evaluated within-day (intra-tester, inter-tester) and between-day (test-retest) reliability of a novel spinal wheel device measuring thoracic and lumbar postures during sitting and standing. 17 healthy volunteers (age 39.5 +/- 5.4, BMI 25 +/- 9.2; 9 males) were measured three times, by three testers, on two separate occasions (1 week apart). The angular change between C7 and T12 and between T12 and S1 provided thoracic and lumbar curvatures, respectively. Intra-class correlation coefficient (ICC) with 95% confidence intervals and typical error were calculated. Excellent reliability was demonstrated with intra-tester ICCs between 0.947 and 0.980 and typical error between 1.7 degrees and 3.7 degrees and inter-tester ICCs between 0.949 and 0.986 and typical error between 2.0 degrees and 4.7 degrees. Test-retest reliability was high with ICCs 0.719-0.908 and typical error between 4.0 degrees and 7.4 degrees. In conclusion, the spinal wheel demonstrated excellent within-day and high between-day reliability. The device may be used in conjunction with 2D camcorder to provide clinically useful visual evaluation of postures for assessment, intervention monitoring, and feedback during postural re-education.

Background/Aims: Differences in regional lumbar angles in sitting have been observed between subgroups of patients with non-specific chronic low back pain (NSCLBP) exhibiting motor control impairments (MCI). However, differences during standing posture and functional tasks, as well as differences in thoracic kinematics, have not been explored to date. This study aimed to compare regional spinal angles in healthy and MCI subgroups during static postures and functional tasks. Methods: An observational, cross-sectional study investigated spinal kinematics of two subgroups of patients with NSCLBP--flexion pattern (FP) (n=28) and active extension pattern (AEP) (n=23)--and healthy controls (n=28) using 3D motion analysis (Vicon) during usual sitting, usual standing, sit-to-stand and a bending task (to pick up a pen). Results: Significant differences (p<0.05) were observed between the AEP and (p≤0.005) and lower lumbar (LLx) (p≤0.033) during all postures and tasks, with the exception of lower thoracic (LTx) angle during standing (p=0.058). Significant differences in total thoracic (TotTx) between AEP and FP were evident during usual sitting and sit-to-stand (p≤0.038). Significant differences were also observed between FP and control groups in the ULx and LTx spine, with the exception of ULx during sit-to-stand (p=0.096) and standing (p=0.058). No differences in TotTx, UTx or LLx, or between the AEP and control group, were observed in any posture or task. Conclusions: Observing subdivided regional spinal angles is key to identifying MCI subgroup differences, with ULx and LTx able to discriminate between FP and AEP, and FP and healthy controls during static postures and functional tasks. [ABSTRACT FROM AUTHOR]