Disorders in trunk rotation during walking in patients with low back pain:a dynamical systems approach

Objective. (1) To introduce an evaluation tool for the assessment of walkin g disorders in low back pain patients, (2) To investigate whether walking p atterns in low back pain patients are different from those of control subje cts, Design. Relative phase measures of movement coordination are applied in the assessment of trunk function in a small group of patients with non-specifi c low back pain and in control subjects. Background. Normal subjects change the coordination of pelvic and thoracic rotations from an in-phase to an out-of-phase pattern with increasing walki ng speed. Low back pain patients may have a reduced ability to counter rota te pelvis and thorax at higher walking speeds (from 1.0 m/s onwards) as a r esult of hyperstable coordination patterns. Methods. Six patients with non-specific low back pain and six healthy contr ol subjects walked on a treadmill at comfortable walking speeds and during a systematic variation of the treadmill velocity. Coordination of arm and l eg movements as well as of pelvic and thoracic rotations was analyzed using a relative phase algorithm. Results and Conclusions. The comfortable walking speed was reduced in the p atient group. In contrast to the control subjects, four of the six patients were not able to establish an out-of-phase coordination pattern between th orax and pelvis at higher walking speeds. This coincided with an increased stability of movement coordination, indicating guarded behavior. In additio n, an increased asymmetry between the phase-relations of left and right sid e of the body was found in some of the patients.