Date of Award

Spring 5-18-2015

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Lee Cabell, Ed.D

Committee Member

Fortunato Battaglia, Ph.D

Committee Member

Raju Parasher, Ed.D

Keywords

Low, back, pain, instability, classification, step

Abstract

Background: Low back pain (LBP) affect a majority of the population. Lumbar instability has been identified as a factor in a significant portion of individuals with LBP but movement characteristics of this population has seen limited research regarding functional tasks. Objective: This study examined biodynamic parameters during a step task. Design: Quasi-experimental with 2 factors, group and side (L/R), and 1 repeated measure (stepping). Statistics: Two-way Mixed-Design Repeated Measures ANOVA with Alpha = .05. Movement task: Subjects with LBP and lumbar spine clinical instability classification (N=11) and control subjects (N=11) performed a step down task from a 9.5 inch height on left and right side. Main outcomes: sEMG activation (%MVC), sEMG onset time at first weight acceptance, Ground Reaction Force; rise time GRF(z) and 3D trunk range of motion (ROM) related to three phases of the step: (1) First single leg support, (2) double support and (3) second single leg support. Main results: ROM was reduced in the LBP group in the full step phase in the sagittal plane (p=.003, power= .99), in the final phase in the frontal plane (p=.021, power=.99) and in the transverse plane (p=.018, power=.99) on left steps. GRF(z) was slower in the LBP group at first weight acceptance when leading with the left leg (p=.016, power= .99). EMG onsets: The LBP group had delayed muscle onsets of the right hip abductors (p=.043, power=.99), left abdominals with left stepping (p=.008, power=.91) and right lumbar extensors with right stepping (p=.025, power=.93). The LBP group had delayed onset of right lumbar extensors with right stepping but earlier onset with left stepping (p=.025, power.93). EMG activation levels was higher in the LBP group in both left and right steps of right lumbar extensors (p=.047, power=.93), right hip abductors (p=.017, power= .68) and left hip abductors (p= .035, power= .96). Conclusion: Subjects with LBP demonstrated a high-load movement strategy during this low-load step task with reduced ROM, increased muscle activation, delayed muscle onsets and slow GRF(z) rise time. Left stepping presented more challenge for this group of predominantly right-footed subjects with LBP classified with lumbar instability.

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