Heavy backpacks have been suggested to have a pathogenic role in experience of low back pain among children. We have conducted a repeated-measure study to investigate the backpack-induced changes in lumbo-pelvic coordination of forty gender-balanced college age students when they walked and jogged on a treadmill with two different types of backpacks: normal and ergonomically modified. The backpack-induced changes in lumbo-pelvic coordination were larger when carrying an ergonomically modified vs. a normal backpack as well as when jogging versus walking. The larger changes in lumbo-pelvic coordination when carrying an ergonomically modified backpack were likely due to kinematic restraints imposed by rigidity and enhanced attachments devised in the backpack for increased comfort. Given the role of lower back biomechanics in low back pain, the effects of such larger mechanical abnormalities in the lower back when carrying an ergonomically-modified backpack on risk of low back pain among children requires further investigation.

The effectiveness of exercise has been increasingly studied as exercise has been popular for the improvement of physical performance and rehabilitation of lumbar spine. A variety of exercises have been used to reduce back pain or spinal degeneration. However, there are no studies to determine effects of exercise on lumbar spine kinematics, including lumbar-pelvic coordination and instantaneous axis of rotation. The current study aimed to examine these lumbar spine kinematical changes due to exercise and therapy. We hypothesized that exercise and therapy will affect the changes of lumbar spine kinematics. Lumbar-Pelvic motions were recorded from 86 healthy subjects while performing lifting and lowering tasks of 10% and 25% of body weight. The influence of exercise was quantified from coefficients of curve-fitting for pelvic and lumbar angles. There was a significant difference (p<0.05) for the range of lumbar motion (distribution, D) between the control group and the cardiovascular exercise group after 12-week program. However, there was no significance for lumbar-pelvic coordination, C. A second study was performed to investigate the changes of instantaneous axis of rotation (IAR) at which trunk angle reached 25º. Results indicated that a superior-inferior location of IAR was significantly (p<0.05) modified by the cardiovascular exercise after 12 weeks, but there was no significant effectiveness of the physical therapy exercise. Finding of lumbar spine kinematics during lifting and lowering a weight which are the most popular manual handling activities may provide great understanding of the exercise effectiveness. Future studies are recommended to assess whether the changes of lumbar spine kinematics lead to the decrease instances of lumbar spine injuries or low back pain. / Master of Science

Abnormal lumbar movement has been observed in individuals who have a history of low back pain (LBP). Affected individuals display a reduction in lumbar spine rotation during trunk movement tasks, while pelvic rotation increases to compensate. Reduced lumbar contribution to forward bending is associated with increased compressive forces and increased shearing demand of the task on the lower back. This abnormal lumbo-pelvic coordination (LPC) can persist beyond LBP symptom alleviation and may contribute to further occurrences or more severe cases of LBP. This study serves as a first step in investigating if abnormal LPC can be corrected with a hip orthosis by examining the effects of the device on the LPC of healthy individuals. Twenty participants without presence or history of LBP were recruited to participate in a repeated measures study, completing trunk motion tasks with and without a hip orthosis. In a random order, participants completed forward bending and backward return, lateral bending to the left and right, and axial twisting to the left and right. Thoracic, lumbar, and pelvic rotation along with lumbar-thoracic ratio (LTR) were calculated for each of the movement tasks. Thoracic rotation (total trunk movement) was not significantly altered (p > 0.05, F=0.633) by the application of the hip orthosis. LTR was significantly increased (p < 0.001, F=2.96) with the orthosis by 32%, 22%, 12%, 4%, and 12% for axial twisting left, axial twisting right, lateral bending left, lateral bending right, and forward bending, respectively. This indicates lumbar contributions were increased by physically restricting the pelvis. The effects of a hip orthosis should be further investigated in LBP patients to verify correction of an abnormal LPC.

Abnormalities in lumbopelvic rhythm (LPR) play a role in occurrence/recurrence of low back pain (LBP). The LPR before spinal fusion surgery and its changes following the surgery are not understood. A repeated measure study was designed to investigate timing and magnitude aspects of LPR in a group of patients (n = 5) with LBP before and after a spinal fusion surgery. Participants completed a forward bending and backward return task at their preferred pace in the sagittal plane. The ranges of thoracic and pelvic rotations and lumbar flexion (as the magnitude aspects of LPR) as well as the mean absolute relative phase (MARP) and deviation phase (DP) between thoracic and pelvic rotations (as the timing aspects) were calculated. Thoracic, pelvic, and lumbar rotations/flexion were respectively 2.19° smaller, 17.69° larger, and 19.85° smaller after the surgery. Also, MARP and DP were smaller during both bending (MARP: 0.0159; DP 0.009) and return (MARP: 0.041; DP: 0.015) phases of the motion after surgery. The alterations in LPR after surgery can be the result of changes in lumbar spine structure due to vertebral fusion and/or new neuromuscular adaptations in response to the changes of lumbar spine structure. The effects of altered LPR on load sharing between passive and active components of lower back tissues and the resultant spinal loads should be further investigated in patients with spinal fusion surgery.

Prior studies have reported differences in lower back biomechanics during activities of daily living between individuals with and without chronic low back pain (LBP). Nevertheless, the literature on lower back biomechanics of patients with non-chronic LBP is scant. Therefore, the objective of this study, as the first step towards future prospective studies, was to investigate the lower back biomechanics in patients with non-chronic LBP. Case-control studies were conducted wherein measures of lumbo-pelvic coordination during bending and return tasks as well as measures of mechanical demand on the lower back during lifting tasks in the sagittal plane were investigated between patients with non-chronic LBP and matched asymptomatic individuals. Patients were enrolled into the study at the non-chronic stage of their LBP. We found distinct difference in measures of lumbo-pelvic coordination as well as mechanical demands on the lower back between patients with non-chronic LBP and controls. Reduced lumbar range of flexion and slower task pace as well as the more in-phase and less variable lumbo-pelvic coordination observed in patients with non-chronic low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Such a neuromuscular adaptation, however, resulted in a larger shearing demand on the lower back. Persistent abnormal lumbo-pelvic coordination might play a role in transition to chronic stage or recurrence of LBP. However, such inferences need to be further investigated using prospective studies as well as clinical trials involving a combination of physical and psychological treatments aimed at correction of lumbo-pelvic coordination.