Spinal segments do not move together predictably during daily activities

Enrica Papi, Anthony M J Bull, Alison H McGregor, Enrica Papi, Anthony M J Bull, Alison H McGregor

Abstract

Background: Considering the thoracic, lumbar spine or whole spine as rigid segments has been the norm until recent studies highlighted the importance of more detailed modelling. A better understanding of the requirement for spine multi-segmental analysis could guide planning of future studies and avoid missing clinically-relevant information.

Research question: This study aims to assess the correlation between adjacent spine segments movement thereby evaluating segmental redundancy in both healthy and participants with low back pain (LBP).

Methods: A 3D motion capture system tracked the movement of upper and lower thoracic and lumbar spine segments in twenty healthy and twenty participants with LBP. Tasks performed included walking, sit-to-stand and lifting, repeated 3 times. 3D angular kinematics were calculated for each spine segment. Segmental redundancy was evaluated through cross-correlation (Rxy) analysis of kinematics time series and correlation of range of motion (RROM) of adjacent spine segments.

Results: The upper/lower lumbar pairing showed weak correlations in the LBP group for all tasks and anatomical planes (Rxyrange:0.02-0.36) but moderate and strong correlations during walking (Rxy _frontalplane:0.4) and lifting (Rxy _sagittalplane:0.64) in the healthy group. The lower thoracic/upper lumbar pairing had weak correlations for both groups during lifting and sit-to-stand in the frontal plane and for walking (Rxy:0.01) in the sagittal plane only. The upper/lower thoracic pairing had moderate correlations during sit-to-stand in sagittal and transverse plane in patients with LBP (Rxy _sagittalplane:0.41; Rxy _transverse plane:-0.42) but weak in healthy (Rxy _sagittalplane:0.23; Rxy _transverseplane:-0.34); the contrary was observed during lifting. The majority of RROM values (55/72) demonstrated weak correlations.

Significance: The results suggest that multi-segmental analysis of the spine is necessary if spine movement characteristics are to be fully understood. We cannot establish a priori where redundancy occurs based on healthy data, therefore extra consideration should be made when planning studies with pathological cohorts.

Keywords: Cross-correlation; Kinematics; Low back pain; Motion analysis; Multi-segment.

Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Schematic of marker placement and spine anatomical frames of reference (left side); Joint coordinate system axes of rotation for each spine segment considered (right side).
Fig. 2
Fig. 2
Detection of picking and lowering phase cycles based on T1 vertical displacement and velocity. Coloured triangles show the beginning and end of each phase.
Fig. 3
Fig. 3
Detection of STS cycle based on the right PSIS vertical displacement and velocity. Coloured triangles show the beginning (blue) and end (red) of STS phase.
Fig. 4
Fig. 4
ROM mean (±standard deviation) of thoracic and lumbar spine segments in the 3 anatomical planes for all tasks analysed for people with (grey bars) and without LBP (light grey bars).

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