Trunk Reaction Time and Kinematic Changes Following Slip Perturbations in Subjects with Recurrent Low Back Pain
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Trunk Reaction Time and Kinematic Changes Following Slip Perturbations in Subjects with Recurrent Low Back Pain PAUL S. SUNG
and PAMELA DANIAL
Doctoral Program in Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI 48859, USA (Received 23 August 2017; accepted 16 December 2017) Associate Editor Dan Elson oversaw the review of this article.
Abstract—Postural responses following slip perturbations are critical to fall prevention strategies. It is unclear how postural reactions with a handheld task can validly be transferred to treadmill-induced slip perturbations in subjects with recurrent low back pain (LBP). The purpose of this study was to investigate trunk reaction times and trunk flexion angle as well as velocity following the slips between subjects with and without LBP. There were 29 subjects with LBP and 40 control subjects who participated in the study. Three levels of consecutive treadmill-induced slip perturbations were introduced at level 1 (duration: 0.10 s, velocity: 0.24 m/s, displacement: 1.20 cm), level 2 (0.12 s, 0.72 m/s, 4.32 cm), and level 3 (0.12 s, 1.37 m/s, 8.22 cm). The trunk reaction time, swing/step times, and trunk flexion angle as well as velocity at heel strike/toe-off were compared between the groups. There were significantly longer trunk reaction times (t = 2 2.03, p = 0.04), swing times (t = 2 2.63, p = 0.01), and step times (t = 2 2.53, p = 0.01) in the LBP group at the level 1 slip perturbation. The groups demonstrated a significant interaction between the levels and trunk flexion angles (F = 4.72, p = 0.03), but there was no interaction between the levels and trunk flexion velocities (F = 0.07, p = 0.79). The LBP group demonstrated longer reaction times at the level 1 perturbation due to a possible pain recurrence. However, this compensatory tolerance was limited at the level 3 perturbation due to increased trunk flexion angle at heel strike and toe-off in the LBP group. Clinicians may consider a compensatory strategy to improve reaction time and minimize trunk flexion following slip perturbations in patients with LBP. Keywords—Kinematic, Slip, Perturbations, Low back pain, Motor learning, Compensation.
Address correspondence to Paul S. Sung, Doctoral Program in Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI 48859, USA. Electronic mail: [email protected]
ABBREVIATION LBP BMI VAS ODI ANOVA r
Low back pain Body mass index Visual analog scale Oswestry Disability Index Analysis of variance Pearson correlation coefficient
INTRODUCTION Low back pain (LBP) affects up to 80% of the population and is the cause of disability for 1–2% of American older adults.7 Although LBP resolves in the majority of patients in approximately 6 weeks, at least 5% of patients develop recurrent LBP after the initial injury.23 Those subjects with recurrent LBP
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