Original articleBiomechanical assessments of lumbar spinal function. how low back pain sufferers differ from normals. implications for outcome measures research. part i: kinematic assessments of lumbar function
Introduction
Assessing and identifying lumbar spine dysfunction in patients with low back pain (LBP) is necessary in the development of objective outcome measures of spinal function. If, as previously postulated, an anatomical diagnosis for low back conditions is impossible 80% to 90% of the time,1 being able to differentiate normal spinal function from what is abnormal may be fundamental in creating a diagnosis based on spinal function rather than aberrant anatomy. A diagnosis based on function via tools and techniques to quantify dysfunction provides a means to assess a patient's current condition separate from their subjective perception of pain. Although presently unknown, biomechanical assessment techniques that categorize patients with different functional characteristics may help determine the patients which respond best to different therapies. It is possible that patients with low back pain may have completely different functional inadequacies and only the use of advanced assessments of spine function will describe and identify these dysfunctions. It is then possible that patients with different functional inadequacies may respond better to treatment aimed at correcting their functional limitations. Currently, this is unknown and future research using these biomechanical assessment techniques can address these possibilities. Additionally, biomechanical assessment techniques may provide insight into the various physiological effects of commonly used chiropractic therapeutics that may currently lack an identified mechanism for their clinical effectiveness (ie, spinal manipulation, specific exercise programs, physical therapy modalities).
The aim of this review is to introduce the reader to new biomechanical assessment techniques for the lumbar spine. This article will not thoroughly review traditional outcome measures (end range of motion [ROM], trunk strength, simple measures of trunk muscle electromyographic [EMG] amplitude, pain scoring, and motion palpation). Rather, this article will review biomechanical assessment techniques that are currently used in spine biomechanics laboratories, yet have not been used as outcome measures in the clinical research investigating chiropractic therapy. The biomechanical differences that evidence themselves using these biomechanical assessment techniques between patients with low back pain and pain-free controls will be reviewed. I hope that with future research many of these assessment techniques could be incorporated into clinical research and practice to improve the assessment of spinal function and possibly improve or validate therapy. This review is limited to noninvasive biomechanical measurement procedures. For the most part, investigations using imaging techniques or needle electromyograms are not reviewed; nor will this review assess motion or static palpation of lumbar musculature or joints of the spine. It is the intent of this review to provide the clinician and researcher with an introduction to the current and latest techniques used to assess spinal function and the manner in which low back injury has been documented to influence the measurable function of the lumbar spine.
For this article, biomechanical assessment techniques will be split into 2 broad categories: kinematic measures of lumbar function and electromyographic measures of lumbar function (companion part II paper).
Section snippets
Kinematic measures of lumbar function
Kinematic assessments of lumbar function require the measurement of the position of the lumbar spine in space. This is typically done through 2 means: video analysis and electrogoniometer techniques. Both methods can provide 3-dimensional dynamic tracking of spinal movements. These measures of spinal movement are that of spinal regions, ie, the lumbar spine, rather than individual motion segment movement. In addition to simple end range of motion, these techniques can provide a movement profile
Conclusion
By documenting the spinal higher order kinematics and proprioception, patients may be able to be categorized based on these functional parameters. Rehabilitation programs may be designed to specifically target these dysfunctions once it is determined which type of rehabilitation interventions best influence specific characteristics of spinal function. Perhaps a patient only has proprioceptive deficits but no higher order kinematic deficits. Treatment can be appropriately tailored. Or, with
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