Alteration of movement patterns in low back pain assessed by Statistical Parametric Mapping

Abstract

Changes in movement pattern in low back pain (LBP) groups have been analysed by reporting predefined discrete variables. However, this approach does not consider the full kinematic data waveform and its dynamic information, potentially exposing the analysis to bias. Statistical Parametric Mapping (SPM) has been introduced and applied to 1 dimensional (D) kinematic variables allowing the assessment of data over time. The aims of this study were to assess differences in 3D kinematics patterns in people with and without LBP during functional tasks by using SPM and to investigate if SPM analysis was consistent with standard 3D range of motion (RoM) assessments. 3D joints kinematics of the spine and lower limbs were compared between 20 healthy controls and 20 participants with non-specific LBP during walking, sit-to-stand and lifting. SPM analysis showed significant differences in the 3Dkinematics of the lower thoracic segment, upper and lower lumbar segment and knee joint during walking and lifting mostly observed at the beginning and/or towards the end of the tasks. ROMs differed between groups in the lower thoracic segment (walking/sit-to-stand), upper and lower lumbar segments (walking/sit-to-stand/lifting), hip and knee (sit-to-stand/lifting). Based on these results, the two approaches can yield different data interpretations. SPM analysis allows the identification of differences in movement that occur over time. This adds value to LBP movement analysis as it allows an understanding of the LBP strategies adopted during motion that may not be conveyed by simple discrete parameters such as ROMs.

Keywords: 3D motion analysis; Kinematics; Range of motion; Time series analysis.

Fig. 1

Mean 3D lower limbs joint angles during walking, STS, lifting (lowering and picking phases) for healthy (red lines) and LBP participants (blue lines). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Mean 3D spine segments angles during walking, STS, lifting (lowering and picking phases) for healthy (red lines) and LBP participants (blue lines). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Mean and SD of ROM values in the three anatomical planes (C: coronal, T: transverse. S: sagittal plane) for the spine segments (UT: upper thoracic, LT: lower thoracic, UL: upper lumbar, LL: lower lumbar) for healthy (dark grey bars) and LBP participants (light grey bars). * indicates significant differences.

Fig. 4

Mean and SD of ROM values in the three anatomical planes (C: coronal, T: transverse. S: sagittal plane) for hip (H), knee (K) and ankle (A) joints and pelvis segment (P) for healthy (dark grey bars) and LBP participants (light grey bars). * indicates significant differences.

Fig. 5

Results of SPM Hotelling T² test parametric and non-parametric (SPM{T²} or SnPM{T²}, Panel A) and post-hoc analysis (SPM{t} or SnPM{t}, Panel B-D) during walking. Each row refers to a different body segment or joint where significant differences were found. Supra-thresholds clusters indicating significance difference between healthy and LBP participants are shown in grey and the critical threshold as red dashed line. Panels B, C and D show differences in the coronal, transverse and sagittal plane angle respectively from the post-hoc analysis. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 6

Results of SPM Hotelling T² test parametric and non-parametric (SPM{T²} or SnPM{T²}, Panel A) and post-hoc analysis (SPM{t} or SnPM{t}, Panel B-D) during the lowering phase of lifting. Each row refers to a different body segment or joint where significant differences were found. Supra-thresholds clusters indicating significance difference between healthy and LBP participants are shown in grey and the critical threshold as red dashed line. Panels B, C and D show differences in the coronal, transverse and sagittal plane angle respectively from the post-hoc analysis. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 7

Results of SPM Hotelling T² test parametric and non-parametric (SPM{T²} or SnPM{T²}, Panel A) and post-hoc analysis (SPM{t} or SnPM{t}, Panel B-D) during the picking phase of lifting. Each row refers to a different body segment or joint where significant differences were found. Supra-thresholds clusters indicating significance difference between healthy and LBP participants are shown in grey and the critical threshold as red dashed line. Panels B, C and D show differences in the coronal, transverse and sagittal plane angle respectively from the post-hoc analysis. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)