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Register a new userWalking and running with non-specific chronic low back pain: what about the lumbar lordosis angle?
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Non-specific chronic low back pain (NSCLBP) is a major health problem, affecting about one fifth of the population worldwide. To avoid further pain or injury, patients with NSCLBP seem to adopt a stiffer movement pattern during everyday living activities. However, it remains unknown how NSCLBP affects the lumbar lordosis angle (LLA) during repetitive activities such as walking or running. This pilot study therefore aimed at exploring possible NSCLBP-related alterations in LLAs during walking and running by focusing on discrete parameters as well as continuous data. Thirteen patients with NSCLBP and 20 healthy pain-free controls were enrolled and underwent a full-body movement analysis involving various everyday living activities such as standing, walking and running. LLAs were derived from markers placed on the spinous processes of the vertebrae L1-L5 and S1. Possible group differences in discrete (average and range of motion (ROM)) and continuous LLAs were analyzed descriptively using mean differences with confidence intervals ranging from 95% to 75%. Patients with NSCLBP indicated reduced average LLAs during standing, walking and running and a tendency for lower LLA-ROM during walking. Analyses of continuous data indicated the largest group differences occurring around 25% and 70% of the walking and 25% and 75% of the running cycle. Furthermore, patients indicated a reversed movement pattern during running, with increasing instead of a decreasing LLAs after foot strike. This study provides preliminary evidence that NSCLBP might affect LLAs during walking and running. These results can be used as a basis for future large-scale investigations involving hypothesis testing.
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Objective: A numerical 3D model of the human trunk was developed to study the biomechanical effects of lumbar belts used to treat low back pain. Methods: This model was taken from trunk radiographies of a person and simplified so as to make a parametric study by varying morphological parameters of the patient, characteristic parameters of the lumbar belt and mechanical parameters of body and finally to determine the parameters influencing the effects of low back pain when of wearing the lumbar belt. The loading of lumbar belt is modelled by Laplaces law. These results were compared with clinical study. Results: All the results of this parametric study showed that the choice of belt is very important depending on the patients morphology. Surprisingly, the therapeutic treatment is not influenced by the mechanical characteristics of the body structures except the mechanical properties of intervertebral discs. Discussion: The numerical model can serve as a basis for more in-depth studies concerning the analysis of efficiency of lumbar belts in low back pain. In order to study the impact of the belts architecture, the pressure applied to the trunk modelled by Laplaces law could be improved. This model could also be used as the basis for a study of the impact of the belt over a period of wearing time. Indeed, the clinical study shows that movement has an important impact on the distribution of pressure applied by the belt.
Lifting up objects from the floor has been identified as a risk factor for low back pain, whereby a flexed spine during lifting is often associated with producing higher loads in the lumbar spine. Even though recent biomechanical studies challenge these assumptions, conclusive evidence is still lacking. This study therefore aimed at comparing lumbar loads among different lifting styles using a comprehensive state-of-the-art motion capture-driven musculoskeletal modeling approach. Thirty healthy pain-free individuals were enrolled in this study and asked to repetitively lift a 15 kg-box by applying 1) a freestyle, 2) a squat and 3) a stoop lifting technique. Whole-body kinematics were recorded using an optical motion capture system and used to drive a full-body musculoskeletal model including a detailed thoracolumbar spine. Compressive, shear and total loads were calculated based on a static optimization approach and expressed as factor body weight (BW). In addition, lumbar lordosis angles and total lifting time were calculated. All parameters were compared among the lifting styles using a repeated measures design. For all lumbar segments, stoop lifting showed significantly lower compressive and total loads (-0.3 to -1.0BW) when compared to freestyle and squat lifting. Stoop lifting produced higher shear loads (+0.1 to +0.8BW) in the segments T12/L1 to L4/L5, but lower loads in L5/S1 (-0.2 to -0.4BW). Peak compressive and total loads during squat lifting occurred approximately 30% earlier in the lifting cycle compared to stoop lifting. Stoop lifting showed larger lumbar lordosis range of motion (35.9+/-10.1{deg}) than freestyle (24.2+/-7.3{deg}) and squat (25.1+/-8.2{deg}) lifting. Lifting time differed significantly with freestyle being executed the fastest (4.6+/-0.7s), followed by squat (4.9+/-0.7s) and stoop (5.9+/-1.1s).
Chronic pain is recognized as a major health problem, with impacts not only at the economic, but also at the social, and individual levels. Being a private and subjective experience, it is impossible to externally and impartially experience, describe, and interpret chronic pain as a purely noxious stimulus that would directly point to a causal agent and facilitate its mitigation, contrary to acute pain, the assessment of which is usually straightforward. Verbal communication is, thus, key to convey relevant information to health professionals that would otherwise not be accessible to external entities, namely, intrinsic qualities about the painful experience and the patient. We propose and discuss a topic modelling approach to recognize patterns in verbal descriptions of chronic pain, and use these patterns to quantify and qualify experiences of pain. Our approaches allow for the extraction of novel insights on chronic pain experiences from the obtained topic models and latent spaces. We argue that our results are clinically relevant for the assessment and management of chronic pain.
Musculoskeletal models have the potential to improve diagnosis and optimize clinical treatment by predicting accurate outcomes on an individual basis. However, the subject-specific modeling of spinal alignment is often strongly simplified or is based on radiographic assessments, exposing subjects to unnecessary radiation. We therefore developed a novel skin marker-based approach for modeling subject-specific spinal alignment and evaluated its feasibility by comparing the predicted with the actual intervertebral joint (IVJ) locations/orientations (ground truth) using lateral-view radiographic images. Moreover, the predictive performance of the subject-specific models was evaluated by comparing the predicted L1/L2 spinal loads during various functional activities with in vivo measured data obtained from the OrthoLoad database. IVJ locations/orientations were predicted closer to ground truth as opposed to standard model scaling, with average location prediction errors of 0.99+/-0.68 cm on the frontal and 1.21+/-0.97 cm on the transverse axis as well as an average orientation prediction error of 4.74{deg}+/-2.80{deg}. Simulated spinal loads showed similar curve patterns but considerably larger values as compared to in vivo measured data. Differences in spinal loads between generic and subject-specific models become only apparent on an individual subject level. These results underline the feasibility of the proposed method and associated workflow for inter- and intra-subject investigations using musculoskeletal simulations. When implemented into standard model scaling workflows, it is expected to improve the accuracy of muscle activity and joint loading simulations, which is crucial for investigations of treatment effects or pathology-dependent deviations.
The pathogenesis of adolescent idiopathic scoliosis (AIS) remains poorly understood and biomechanical data are limited. A deeper insight into spinal loading could provide valuable information for the improvement of current treatment strategies. This work therefore aimed at using subject-specific musculoskeletal full-body models of patients with AIS to predict segmental compressive forces around the curve apex and to investigate how these forces are affected by simulated load carrying. Models were created based on spatially calibrated biplanar radiographic images from 24 patients with mild to moderate AIS and validated by comparing predictions of paravertebral muscle activity with reported values from in vivo studies. Spinal compressive forces were predicted during unloaded upright standing as well as upright standing with external loads of 10%, 15% and 20% of body weight (BW) applied to the scapulae to simulate carrying a backpack in the regular way, in front of the body and over both shoulders. The validation studies showed higher convex muscle activity, which was comparable to the literature. The implementation of spinal deformity resulted in a 10% increase of compressive force at the curve apex during unloaded upright standing. Apical compressive forces further increased by 50-62%, 77-94% and 103-128% for 10%, 15% and 20% BW loads, respectively. Moreover, load-dependent compressive force increases were the lowest in the regular backpack and the highest in the frontpack and convex conditions. The predictions indicated increased segmental compressive forces during unloaded standing, which could be ascribed to the scoliotic deformation. When carrying loads, compressive forces further increased depending on the carrying mode and the weight of the load. These results can be used as a basis for further studies investigating segmental loading in AIS patients during functional activities.
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