The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Relationship of Impaired Lumbar Spine-Hip Coordination During Sit To Stand and Stand To Sit with Functional Disability in Chronic Nonspecific Low Back Pain Patients

Document Type : RESEARCH PAPER

Authors
MohammadReza Pourahmadi 1
Alireza Mollaei Barejahri 2
Mohamad Sahebalam 1
Rasool Bagheri 3
1 Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
2 Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
3 Neuromuscular Rehabilitation Research Center, Department of Physiotherapy, Semnan University of Medical Sciences, Semnan, Iran
10.22038/abjs.2022.56903.2822
Abstract
Background: This study aimed to investigate the relationships of lumbar spine-hip discoordination during sit-to-stand
(STD) and stand-to-sit (SIT) with pain and functional disability in chronic nonspecific low back pain (CNLBP) patients.
Methods: A cross-sectional observational study was conducted in a biomechanics laboratory of the physical therapy
department located at the School of Rehabilitation Sciences, Iran University of Medical Sciences (Tehran–Iran). A total
of 16 CNLBP patients (men 9, female 7) aged 18–40 years (mean 31.48) were selected according to our eligibility
criteria. Furthermore, ten reflective markers were placed on the spinous processes of T12 and S2, posterior and
anterior superior iliac spines, greater trochanters, and lateral epicondyles. The patients were instructed to perform
STD and SIT tasks at a preferred speed without using their hands. Relative phase angle was used as an indicator of
coordination and was identified as the inverse tangent of angular displacement/angular velocity. Moreover, the relative
phase angle between the lumbar spine and right and left hip joints was measured by subtracting the phase angle of
the hip joint from the lumbar spine joint. The ratios of the total movements of the lumbar spine to the total movements
of the right and left hip joints were also calculated in the sagittal plane. Finally, Pearson correlation coefficients (r) were
utilized to assess the association between variables.
Results: The results of this study indicated that kinematic parameters of the pain had statistically significant direct
relationships with functional disability in CNLBP participants during STD and SIT with r values ranging from 0.57
(Pvalue = 0.021) to 0.85 (Pvalue<0.001) and 0.54 (Pvalue=0.053) to 0.82 (Pvalue<0.001), respectively.
Conclusion: Out of the results of this study, it could be stated that pain and functional disability play a major role in
lumber spine-hip discoordination, and it altered the movement ratio in CNLBP patients during STD and SIT. In clinical
practice, clinicians should improve lumber spine-hip discoordination in patients with CNLBP since there is a linear
relationship between kinematic parameters of the pain and functional disability in patients with CNLBP.
Level of evidence: II
Keywords
Hip
Functional activity
Joint coordination
Low back pain
Lumbar vertebrae
  1. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015;386(9995):743-800.
  2. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ (Clinical research ed). 2008;337:a171. doi: 10.1136/bmj.a171.
  3. da CMCL, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613-24. doi: 10.1503/cmaj.111271.
  4. O’Sullivan K, O’Sullivan L, Campbell A, O’Sullivan P, Dankaerts W. Towards monitoring lumbo-pelvic posture in real-life situations: concurrent validity of a novel posture monitor and a traditional laboratory-based motion analysis system. Man Ther.2012;17(1):77-83. doi: 10.1016/j.math.2011.09.006.
  5. Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Arch Intern Med.2009;169(3):251-8. doi: 10.1001/archinternmed.2008.543.
  6. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4: European guidelines for the management of chronic nonspecific low back pain. Eur Spine J.2006;15 (Suppl 2):S192-300. doi: 10.1007/s00586-006-1072-1.
  7. Mitchell T, O’Sullivan PB, Burnett AF, Straker L, Smith A. Regional differences in lumbar spinal posture and the influence of low back pain. BMC Musculoskelet Disord.2008;9:152. doi: 10.1186/1471-2474-9-152.
  8. Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom NJ. Movement system impairment-based categories for low back pain: stage 1 validation. J Orthop Sports Phys Ther. 2003;33(3):126-42. doi: 10.2519/jospt.2003.33.3.126.
  9. Van Dillen LR, Gombatto SP, Collins DR, Engsberg JR, Sahrmann SA. Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain. Arch Phys Med Rehabil. 2007;88(3):351-60. doi: 10.1016/j.apmr.2006.12.021.
  10. Sahrmann S. Diagnosis and treatment of movement impairment syndromes. St. Louis, MO: Mosby 2002.
  11. Shum GL, Crosbie J, Lee RY. Symptomatic and asymptomatic movement coordination of the lumbar spine and hip during an everyday activity. Spine (Phila Pa 1976).2005;30(23):E697-702. doi: 10.1097/01.brs.0000188255.10759.7a.
  12. Shum GL, Crosbie J, Lee RY. Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit. Spine (Phila Pa 1976).2005;30(17):1998-2004. doi: 10.1097/01.brs.0000176195.16128.27.
  13. Christe G, Redhead L, Legrand T, Jolles BM, Favre J. Multi-segment analysis of spinal kinematics during sit-to-stand in patients with chronic low back pain. J Biomech. 2016;49(10):2060-7. doi: 10.1016/j.jbiomech.2016.05.015.
  14. Shafizadeh M. Movement coordination during Sit-to-Stand in low back pain people. Human Movement. 2016;17(2):107-11.
  15. Silfies SP, Bhattacharya A, Biely S, Smith SS, Giszter S. Trunk control during standing reach: a dynamical system analysis of movement strategies in patients with mechanical low back pain. Gait Posture. 2009;29(3):370-6. doi: 10.1016/j.gaitpost. 2008.10.053.
  16. Earhart GM, Bastian AJ. Selection and coordination of human locomotor forms following cerebellar damage. J Neurophysiol. 2001;85(2):759-69. doi: 10.1152/jn.2001.85.2.759.
  17. Mayer TG, Gatchel RJ, Keeley J, McGeary D, Dersh J, Anagnostis C. A randomized clinical trial of treatment for lumbar segmental rigidity. spine (Phila Pa 1976). 2004;29(20):2199-205; discussion 206. doi: 10.1097/01.brs.0000142009.73869.8d.
  18. Cimolin V, Capodaglio P, Galli M, eds. Biomechanics of Basic Activities.in: Disabling Obesity. Springer, Berlin, Heidelberg; 2013.
  19. Pourahmadi MR, Takamjani IE, Jaberzadeh S, et al. The effect of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit in patients with chronic nonspecific low back pain (COSCIOUS): Study protocol for a randomized double-blind controlled trial. JMIR Res Protoc. 2017;6(6):e109. doi: 10.2196/resprot.7378.
  20. Chakraverty R, Pynsent P, Isaacs K. Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? J Anat. 2007;210(2):232-6. doi: 10.1111/j.1469-7580.2006.00686.x.
  21. Pourahmadi MR, Taghipour M, Jannati E, Mohseni-Bandpei MA, Takamjani IE, Rajabzadeh F. Reliability and validity of an iPhone® application for the measurement of lumbar spine flexion and extension range of motion. PeerJ. 2016;4:e2355. doi: 10.7717/peerj.2355.
  22. Fernandes R, Armada-da-Silva P, Pool-Goudaazward A, Moniz-Pereira V, Veloso AP. Test-retest reliability and minimal detectable change of three-dimensional gait analysis in chronic low back pain patients. Gait Posture.2015;42(4)
The Archives of Bone and Joint Surgery
Volume 10, Issue 10
October 2022
Pages 892-898

  • Receive Date 16 April 2021
  • Revise Date 02 May 2022
  • Accept Date 14 May 2022