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European Journal of Applied Physiology

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01-11-2015 | Original Article

Energetics and mechanics of walking in patients with chronic low back pain and healthy matched controls

Authors: Yves Henchoz, Nicola Soldini, Nicolas Peyrot, Davide Malatesta

Published in: European Journal of Applied Physiology | Issue 11/2015

Abstract

Purpose

Walking in patients with chronic low back pain (cLBP) is characterized by motor control adaptations as a protective strategy against further injury or pain. The purpose of this study was to compare the preferred walking speed, the biomechanical and the energetic parameters of walking at different speeds between patients with cLBP and healthy men individually matched for age, body mass and height.

Methods

Energy cost of walking was assessed with a breath-by-breath gas analyser; mechanical and spatiotemporal parameters of walking were computed using two inertial sensors equipped with a triaxial accelerometer and gyroscope and compared in 13 men with cLBP and 13 control men (CTR) during treadmill walking at standard (0.83, 1.11, 1.38, 1.67 m s⁻¹) and preferred (PWS) speeds. Low back pain intensity (visual analogue scale, cLBP only) and perceived exertion (Borg scale) were assessed at each walking speed.

Results

PWS was slower in cLBP [1.17 (SD = 0.13) m s⁻¹] than in CTR group [1.33 (SD = 0.11) m s⁻¹; P = 0.002]. No significant difference was observed between groups in mechanical work (P ≥ 0.44), spatiotemporal parameters (P ≥ 0.16) and energy cost of walking (P ≥ 0.36). At the end of the treadmill protocol, perceived exertion was significantly higher in cLBP [11.7 (SD = 2.4)] than in CTR group [9.9 (SD = 1.1); P = 0.01]. Pain intensity did not significantly increase over time (P = 0.21).

Conclusions

These results do not support the hypothesis of a less efficient walking pattern in patients with cLBP and imply that high walking speeds are well tolerated by patients with moderately disabling cLBP.

Åstrand P-O, Rodahl KR (1986) Textbook of work physiology : physiological bases of exercise. McGraw-Hill series in health education, physical education, and recreation. McGraw-Hill, New York

Barker KL, Dawes H, Hansford P, Shamley D (2003) Perceived and measured levels of exertion of patients with chronic back pain exercising in a hydrotherapy pool. Arch Phys Med Rehabil 84(9):1319–1323. pii: S0003999303002661

Beijersbergen CM, Granacher U, Vandervoort AA, DeVita P, Hortobagyi T (2013) The biomechanical mechanism of how strength and power training improves walking speed in old adults remains unknown. Age Res Rev 12(2):618–627. doi:10.1016/j.arr.2013.03.001 CrossRef

Bernardi M, Macaluso A, Sproviero E, Castellano V, Coratella D, Felici F, Rodio A, Piacentini MF, Marchetti M, Ditunno JF Jr (1999) Cost of walking and locomotor impairment. J Electromyogr Kinesiol 9(2):149–157CrossRefPubMed

Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381CrossRefPubMed

Browning RC, Baker EA, Herron JA, Kram R (2006) Effects of obesity and sex on the energetic cost and preferred speed of walking. J Appl Physiol 100(2):390–398CrossRefPubMed

Cavagna GA, Thys H, Zamboni A (1976) The sources of external work in level walking and running. J Physiol 262(3):639–657PubMedCentralCrossRefPubMed

Crosbie J, de Faria Negrao Filho R, Nascimento DP, Ferreira P (2013) Coordination of spinal motion in the transverse and frontal planes during walking in people with and without recurrent low back pain. Spine 38(5):E286–E292. doi:10.1097/BRS.0b013e318281de28 CrossRefPubMed

Detrembleur C, van den Hecke A, Dierick F (2000) Motion of the body centre of gravity as a summary indicator of the mechanics of human pathological gait. Gait Posture 12(3):243–250CrossRefPubMed

Gauthier AP, Lariviere M, Young N (2009) Psychometric properties of the IPAQ: a validation study in a sample of northern Franco-Ontarians. J Phys Act Health 6(1):S54–S60PubMed

Griffin DW, Harmon DC, Kennedy NM (2012) Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature. Physiotherapy 98(1):13–23. doi:10.1016/j.physio.2011.04.350 CrossRefPubMed

Hodges PW (2011) Pain and motor control: from the laboratory to rehabilitation. J Electromyogra Kinesiol Off J Int Soc Electrophysiol Kinesiol 21(2):220–228. doi:10.1016/j.jelekin.2011.01.002 CrossRef

Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 24(6):769–781. doi:10.1016/j.berh.2010.10.002 CrossRefPubMed

Jasiewicz JM, Allum JH, Middleton JW, Barriskill A, Condie P, Purcell B, Li RC (2006) Gait event detection using linear accelerometers or angular velocity transducers in able-bodied and spinal-cord injured individuals. Gait Posture 24(4):502–509. doi:10.1016/j.gaitpost.2005.12.017 CrossRefPubMed

Kuo AD, Donelan JM (2010) Dynamic principles of gait and their clinical implications. Phys Ther 90(2):157–174. doi:10.2522/ptj.20090125 PubMedCentralCrossRefPubMed

Lamoth CJ, Meijer OG, Wuisman PI, van Dieen JH, Levin MF, Beek PJ (2002) Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain. Spine 27(4):E92–E99CrossRefPubMed

Lamoth CJ, Daffertshofer A, Meijer OG, Lorimer Moseley G, Wuisman PI, Beek PJ (2004) Effects of experimentally induced pain and fear of pain on trunk coordination and back muscle activity during walking. Clin Biomech 19(6):551–563. doi:10.1016/j.clinbiomech.2003.10.006 CrossRef

Lamoth CJ, Daffertshofer A, Meijer OG, Beek PJ (2006a) How do persons with chronic low back pain speed up and slow down? Trunk-pelvis coordination and lumbar erector spinae activity during gait. Gait Posture 23(2):230–239. doi:10.1016/j.gaitpost.2005.02.006 CrossRefPubMed

Lamoth CJ, Meijer OG, Daffertshofer A, Wuisman PI, Beek PJ (2006b) Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control. Eur Spine J 15(1):23–40. doi:10.1007/s00586-004-0825-y PubMedCentralCrossRefPubMed

Lamoth CJ, Stins JF, Pont M, Kerckhoff F, Beek PJ (2008) Effects of attention on the control of locomotion in individuals with chronic low back pain. J Neuroeng Rehab 5:13. doi:10.1186/1743-0003-5-13 CrossRef

Lariviere C, Das RA, Arsenault AB, Nadeau S, Plamondon A, Vadeboncoeur R (2010) Specificity of a back muscle exercise machine in healthy and low back pain subjects. Med Sci Sports Exerc 42(3):592–599. doi:10.1249/MSS.0b013e3181b96029 CrossRefPubMed

Lee CE, Simmonds MJ, Etnyre BR, Morris GS (2007) Influence of pain distribution on gait characteristics in patients with low back pain: part 1: vertical ground reaction force. Spine 32(12):1329–1336. doi:10.1097/BRS.0b013e318059af3b CrossRefPubMed

Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW (2007) The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 30(1):77–94. doi:10.1007/s10865-006-9085-0 CrossRefPubMed

Mahaudens P, Detrembleur C, Mousny M, Banse X (2009) Gait in adolescent idiopathic scoliosis: energy cost analysis. Eur Spine J 18(8):1160–1168. doi:10.1007/s00586-009-1002-0 PubMedCentralCrossRefPubMed

Malatesta D, Simar D, Dauvilliers Y, Candau R, Borrani F, Prefaut C, Caillaud C (2003) Energy cost of walking and gait instability in healthy 65- and 80-year-olds. J Appl Physiol 95(6):2248–2256. doi:10.1152/japplphysiol.01106.2002 CrossRefPubMed

Martin PE, Rothstein DE, Larish DD (1992) Effects of age and physical activity status on the speed-aerobic demand relationship of walking. J Appl Physiol 73(1):200–206PubMed

Meichtry A, Romkes J, Gobelet C, Brunner R, Muller R (2007) Criterion validity of 3D trunk accelerations to assess external work and power in able-bodied gait. Gait Posture 25(1):25–32. doi:10.1016/j.gaitpost.2005.12.016 CrossRefPubMed

Miller RP, Kori S, Todd D (1991) The Tampa Scale: a measure of kinesiophobia. Clin J Pain 7(1):51–52CrossRef

Nardello F, Ardigo LP, Minetti AE (2011) Measured and predicted mechanical internal work in human locomotion. Hum Mov Sci 30(1):90–104. doi:10.1016/j.humov.2010.05.012 CrossRefPubMed

Osthus H, Cziske R, Jacobi E (2006) Cross-cultural adaptation of a German version of the Oswestry Disability Index and evaluation of its measurement properties. Spine 31(14):E448–E453. doi:10.1097/01.brs.0000222054.89431.42 CrossRefPubMed

Panjabi MM (2003) Clinical spinal instability and low back pain. J Electromyogr Kinesiol Off J Int Soc Electrophysiol Kinesiol 13(4):371–379. pii: S1050641103000440

Payares K, Lugo LH, Morales V, Londono A (2011) Validation in Colombia of the Oswestry disability questionnaire in patients with low back pain. Spine 36(26):E1730–E1735. doi:10.1097/BRS.0b013e318219d184 CrossRefPubMed

Peyrot N, Thivel D, Isacco L, Morin JB, Duche P, Belli A (2009) Do mechanical gait parameters explain the higher metabolic cost of walking in obese adolescents? J Appl Physiol 106(6):1763–1770. doi:10.1152/japplphysiol.91240.2008 CrossRefPubMed

Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17(1):45–56CrossRefPubMed

Simmonds MJ, Derghazarian T (2009) Lower Back Pain Syndrome. ACSM’s exercise management for persons with chronic diseases and disabilities, 3rd edn. Human Kinetics, Champaign, pp 266–269

Simmonds MJ, Lee CE, Etnyre BR, Morris GS (2012) The influence of pain distribution on walking velocity and horizontal ground reaction forces in patients with low back pain. Pain Res Treat 2012:214980. doi:10.1155/2012/214980 PubMedCentralPubMed

Taylor NF, Evans OM, Goldie PA (2003) The effect of walking faster on people with acute low back pain. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cervical Spine Res Soc 12(2):166–172. doi:10.1007/s00586-002-0498-3

Tesio L, Lanzi D, Detrembleur C (1998) The 3-D motion of the centre of gravity of the human body during level walking II Lower limb amputees. Clin Biomech 13(2):83–90CrossRef

Tonosu J, Takeshita K, Hara N, Matsudaira K, Kato S, Masuda K, Chikuda H (2012) The normative score and the cut-off value of the Oswestry Disability Index (ODI). 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 21(8):1596–1602. doi:10.1007/s00586-012-2173-7 CrossRef

van den Hoorn W, Bruijn SM, Meijer OG, Hodges PW, van Dieen JH (2012) Mechanical coupling between transverse plane pelvis and thorax rotations during gait is higher in people with low back pain. J Biomech 45(2):342–347. doi:10.1016/j.jbiomech.2011.10.024 CrossRefPubMed

van der Hulst M, Vollenbroek-Hutten MM, Rietman JS, Hermens HJ (2010a) Lumbar and abdominal muscle activity during walking in subjects with chronic low back pain: support of the “guarding” hypothesis? J Electromyogr Kinesiol 20(1):31–38. doi:10.1016/j.jelekin.2009.03.009 CrossRefPubMed

van der Hulst M, Vollenbroek-Hutten MM, Rietman JS, Schaake L, Groothuis-Oudshoorn KG, Hermens HJ (2010b) Back muscle activation patterns in chronic low back pain during walking: a “guarding” hypothesis. Clin J Pain 26(1):30–37. doi:10.1097/AJP.0b013e3181b40eca CrossRefPubMed

Vlaeyen JW, Linton SJ (2012) Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 153(6):1144–1147. doi:10.1016/j.pain.2011.12.009 CrossRefPubMed

Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H (1995) Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 62(3):363–372CrossRefPubMed

Vogler D, Paillex R, Norberg M, de Goumoens P, Cabri J (2008) Cross-cultural validation of the Oswestry disability index in French. Ann Readapt Med Phys 51(5):379–385CrossRefPubMed

Vogt L, Pfeifer K, Banzer W (2003) Neuromuscular control of walking with chronic low-back pain. Man Ther 8(1):21–28CrossRefPubMed

Wallbom AS, Geisser ME, Haig AJ, Yamakawa K, Montgomery D (2002) Concordance between rating of perceived exertion and function in persons with chronic, disabling back pain. J Occup Rehabil 12(2):93–98CrossRefPubMed

Title: Energetics and mechanics of walking in patients with chronic low back pain and healthy matched controls
Authors: Yves Henchoz
Nicola Soldini
Nicolas Peyrot
Davide Malatesta
Publication date: 01-11-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Applied Physiology / Issue 11/2015
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI: https://doi.org/10.1007/s00421-015-3227-4

At a glance: The STEP trials

Springer Medicine

Energetics and mechanics of walking in patients with chronic low back pain and healthy matched controls

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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