Abstract
Purpose
The instantaneous center of rotation (ICR) can be used to investigate movement coordination and control in patients with low back pain (LBP). Tracking of the ICR in LBP patients has not been systematically investigated. This study aimed to (1) determine the within-session measurement error of ICR parameters, and (2) characterize the change in ICR among three groups of participants (no history of LBP = HC; history of LBP = HLBP; and current LBP = LBP).
Methods
Ninety-three participants (HC = 31; HLBP = 33; and LBP = 29) were recruited. Participants performed two sets of three repetitions of an active forward bend, while their lumbar and pelvic movements were recorded with an electromagnetic tracking system. Total ICR displacement and the radius of the bounding sphere containing the ICR were derived during the forward bending and the return to upright phases. Intra-class correlation coefficients (ICC3,3) and minimal detectable difference (MDD) were used to determine measurement error and interpret findings of the group analysis. One-way ANOVAs and post hoc Bonferroni comparisons were used to determine differences among groups.
Results
ICC3,3 demonstrated excellent within-session test–retest reliability of the ICR parameters (ICC3,3 = 0.86–0.97). The MDD values were 0.20–3.40 mm. Comparisons between the HC and LBP groups and between the HLBP and LBP groups showed significant differences (p < 0.05) for all ICR parameters, with medium effect sizes (0.51–0.66), except for total displacement during forward bending between the HC and LBP groups.
Conclusion
Less ICR displacement and variability in patients with LBP may indicate coping strategies to stiffen the lumbar spine. This could result from patients with LBP adopting a strategy of increased muscle activation to provide spinal stability during functional tasks.
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References
Luomajoki H, Kool J, de Bruin ED, Airaksinen O (2008) Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. BMC Musculoskelet Disord 9:170. doi:10.1186/1471-2474-9-170
Sahrmann SA (2001) Diagnosis and treatment of movement impairment syndromes. Mosby Publishers, Saint Louis
Biely SA, Silfies SP, Smith SS, Hicks GE (2014) Clinical observation of standing trunk movements: what do the aberrant movement patterns tell us? J Orthop Sports Phys Ther 44(4):262–272. doi:10.2519/jospt.2014.4988
Hicks GE, Fritz JM, Delitto A, McGill SM (2005) Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 86(9):1753–1762
Spinelli BA, Wattananon P, Silfies S, Talaty M, Ebaugh D (2015) Using kinematics and a dynamical systems approach to enhance understanding of clinically observed aberrant movement patterns. Man Ther 20(1):221–226. doi:10.1016/j.math.2014.07.012
Panjabi MM (2003) Clinical spinal instability and low back pain. J Electromyogr Kinesiol 13(4):371–379. doi:10.1016/s1050-6411(03)00044-0
Cossette JW, Farfan HF, Robertson GH, Wells RV (1971) The instantaneous center of rotation of the third lumbar intervertebral joint. J Biomech 4(2):149–153. doi:10.1016/0021-9290(71)90025-X
Sengupta DK, Fan H (2014) The basis of mechanical instability in degenerative disc disease: a cadaveric study of abnormal motion versus load distribution. Spine (Phila Pa 1976) 39(13):1032–1043. doi:10.1097/brs.0000000000000292
Piazza SJ, Erdemir A, Okita N, Cavanagh PR (2004) Assessment of the functional method of hip joint center location subject to reduced range of hip motion. J Biomech 37(3):349–356
Jacobs JV, Henry SM, Jones SL, Hitt JR, Bunn JY (2011) A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. J Neurophysiol 106(5):2506–2514. doi:10.1152/jn.00296.2011
Silfies SP, Squillante D, Maurer P, Westcott S, Karduna AR (2005) Trunk muscle recruitment patterns in specific chronic low back pain populations. Clin Biomech 20(5):465–473. doi:10.1016/j.clinbiomech.2005.01.007
van Dieen JH, Cholewicki J, Radebold A (2003) Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine (Phila Pa 1976) 28(8):834–841
Granata KP, Marras WS (2000) Cost-benefit of muscle cocontraction in protecting against spinal instability. Spine (Phila Pa 1976) 25(11):1398–1404
MacDonald D, Moseley GL, Hodges PW (2009) Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain 142(3):183–188. doi:10.1016/j.pain.2008.12.002
O’Sullivan PB (2005) Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 10(4):242–255. doi:10.1016/j.math.2005.07.001
Sung PS, Danial P (2016) Analysis of relative kinematic index with normalized standing time between subjects with and without recurrent low back pain. Eur Spine J. doi:10.1007/s00586-016-4727-6
Abouhossein A, Weisse B, Ferguson SJ (2013) Quantifying the centre of rotation pattern in a multi-body model of the lumbar spine. Comput Methods Biomech Biomed Engin 16(12):1362–1373. doi:10.1080/10255842.2012.671306
Streisfeld GM, Bartoszek C, Creran E, Inge B, McShane MD, Johnston T (2016) Relationship between body positioning, muscle activity, and spinal kinematics in cyclists with and without low back pain: a systematic review. Sports Health. doi:10.1177/1941738116676260
Mok NW, Brauer SG, Hodges PW (2007) Failure to use movement in postural strategies leads to increased spinal displacement in low back pain. Spine (Phila Pa 1976) 32(19):E537–E543. doi:10.1097/BRS.0b013e31814541a2
Stanton T, Kawchuk G (2008) The effect of abdominal stabilization contractions on posteroanterior spinal stiffness. Spine (Phila Pa 1976) 33(6):694–701. doi:10.1097/BRS.0b013e318166e034
McClure PW, Esola M, Schreier R, Siegler S (1997) Kinematic analysis of lumbar and hip motion while rising from a forward, flexed position in patients with and without a history of low back pain. Spine 22(5):552–558
Gupta A (2001) Analyses of myo-electrical silence of erectors spinae. J Biomech 34(4):491–496
Olson M, Solomonow M, Li L (2006) Flexion-relaxation response to gravity. J Biomech 39(14):2545–2554. doi:10.1016/j.jbiomech.2005.09.009
Colloca CJ, Hinrichs RN (2005) The biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon: a review of literature. J Manip Physiol Ther 28(8):623–631. doi:10.1016/j.jmpt.2005.08.005
Naserkhaki S, Jaremko JL, El-Rich M (2016) Effects of inter-individual lumbar spine geometry variation on load-sharing: geometrically personalized finite element study. J Biomech 49(13):2909–2917. doi:10.1016/j.jbiomech.2016.06.032
Acknowledgements
This research was conducted at the Rehabilitation Sciences Spine Research Laboratories of Drexel University, Philadelphia, PA and Physiotherapy Associates, West Chester, PA. The study was approved by the IRB Committee of Drexel University.
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All authors declared that there was no potential conflict of interest.
Funding
This study was funded in part by the Orthopaedic Section of the American Physical Therapy Association (Silfies) and the Mahidol University Talent Management Program (Wattananon).
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Wattananon, P., Intawachirarat, N., Cannella, M. et al. Reduced instantaneous center of rotation movement in patients with low back pain. Eur Spine J 27, 154–162 (2018). https://doi.org/10.1007/s00586-017-5054-2
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DOI: https://doi.org/10.1007/s00586-017-5054-2