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

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

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


1. Brus I, Speklé E, Kuijer P, Hardenberg M, Coenen P.
Occupational recovery of Dutch workers with low
back pain. Occupational Medicine. 2022.
2. Henschke N, Maher CG, Refshauge KM, Herbert RD,
Cumming RG, Bleasel J, 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.
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 : Canadian
Medical Association journal = journal de l’Association
medicale canadienne. 2012;184(11):E613-24.
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 laboratorybased
motion analysis system. Manual therapy.
2012;17(1):77-83.
5. Freburger JK, Holmes GM, Agans RP, Jackman AM,
Darter JD, Wallace AS, et al. The rising prevalence of
chronic low back pain. Archives of internal medicine.
2009;169(3):251-8.
6. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J,
Klaber-Moffett J, Kovacs F, et al. Chapter 4: European
guidelines for the management of chronic nonspecific
low back pain. European spine journal : official
publication of the European Spine Society, the
European Spinal Deformity Society, and the European
Section of the Cervical Spine Research Society. 2006;15
(Suppl 2):S192-300.
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 Musculoskeletal
Disorders. 2008;9(1):1-11.
8. 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.
9. 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. Journal of Orthopaedic & Sports Physical
Therapy. 2003;33(3):126-42.
10. Shum GL, Crosbie J, Lee RY. Symptomatic and
asymptomatic movement coordination of the lumbar
spine and hip during an everyday activity. Spine.
2005;30(23):E697-702.
11. 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. 2005;30(17):1998-2004.
12. 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.
Journal of biomechanics. 2016;49(10):2060-7.
13. Shafizadeh M. Movement coordination during Sit-to-
Stand in low back pain people. Human Movement.
2016;17(2):107-11.
14. 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.
15. Earhart GM, Bastian AJ. Selection and coordination of
human locomotor forms following cerebellar damage.
Journal of Neurophysiology. 2001;85(2):759-69. 16. Mayer TG, Gatchel RJ, Keeley J, McGeary D, Dersh
J, Anagnostis C. A randomized clinical trial of
treatment for lumbar segmental rigidity. Spine.
2004;29(20):2199-205; discussion 206.
17. Cimolin V, Capodaglio P, Galli M. Biomechanics of Basic
Activities. Disabling Obesity: Springer; 2013. p. 39-53.
18. Pourahmadi MR, Takamjani IE, Jaberzadeh S,
Sarrafzadeh J, Sanjari MA, Mohsenifar H, 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 Research Protocols. 2017;6(6):e109.
19. Chakraverty R, Pynsent P, Isaacs K. Which spinal levels
are identified by palpation of the iliac crests and the
posterior superior iliac spines? Journal of anatomy.
2007;210(2):232-6.
20. 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.
21. Pourahmadi MR, Ebrahimi Takamjani I, Jaberzadeh S,
Sarrafzadeh J, Sanjari MA, Bagheri R, et al. Test-retest
reliability of sit-to-stand and stand-to-sit analysis in
people with and without chronic non-specific low
back pain. Musculoskeletal Science and Practice.
2018;35:95-104.
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):491-7.
23. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A,
Mobini B. The Oswestry Disability Index, the Roland-
Morris Disability Questionnaire, and the Quebec Back
Pain Disability Scale: translation and validation studies
of the Iranian versions. Spine. 2006;31(14):E454-9.
24. Tully EA, Fotoohabadi MR, Galea MP. Sagittal spine and
lower limb movement during sit-to-stand in healthy
young subjects. Gait Posture. 2005;22(4):338-45.
25. Hoffman SL, Johnson MB, Zou D, Van Dillen LR.
Differences in end-range lumbar flexion during
slumped sitting and forward bending between low
back pain subgroups and genders. Manual therapy.
2012;17(2):157-63.
26. Hopkins WG. Research designs: choosing and
fine-tuning a design for your study. Sportscience.
2008;12(1):1-3.
27. Luoto S, Taimela S, Hurri H, Aalto H, Pyykkö I, Alaranta
H. Psychomotor Speed and Postural Control in Chronic
Low Back Pain Patients: A Controlled Follow‐Up Study.
Spine. 1996;21(22):2621-7.
28. Marras WS, Wongsam P. Flexibility and velocity
of the normal and impaired lumbar spine.
Archives of physical medicine and rehabilitation.
1986;67(4):213-7.
29. Pourahmadi M, Sahebalam M, Dommerholt J, Delavari
S, Mohseni-Bandpei MA, Keshtkar A, et al. Spinopelvic
alignment and low back pain after total hip
arthroplasty: a scoping review. BMC musculoskeletal
disorders. 2022;23(1):250.
30. Sung PS. A kinematic analysis for shoulder and pelvis
coordination during axial trunk rotation in subjects
with and without recurrent low back pain. Gait &
posture. 2014;40(4):493-8.
31. Duclos C, Nadeau S, Lecours J. Lateral trunk
displacement and stability during sit-to-stand
transfer in relation to foot placement in patients with
hemiparesis. Neurorehabilitation and Neural Repair.
2008;22(6):715-22.
Volume 10, Issue 10
October 2022
Pages 892-898
  • Receive Date: 16 April 2021
  • Revise Date: 02 May 2022
  • Accept Date: 14 May 2022
  • First Publish Date: 04 September 2022