Changes in Trunk Kinematics in People with Chronic Non-Specific Low Back Pain Using Wearable Inertial Sensors †
by
,
Batlkham Dambadarjaa
1, 
Batbayar Khuyagbaatar
2,*,
Damdindorj Boldbaatar
3,
Baljinnyam Avirmed
4 and
Munkh-erdene Bayartai
1,* 1
Department of Physical Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar 14191, Mongolia
2
Biomechanical Research Laboratory, Mongolian University of Science and Technology, Ulaanbaatar 14191, Mongolia
3
Research and International Affairs, Mongolian National University of Medical Sciences, Ulaanbaatar 14191, Mongolia
4
Department of Rehabilitation Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar 14191, Mongolia
*
Authors to whom correspondence should be addressed.
†
Presented at the 10th International Electronic Conference on Sensors and Applications (ECSA-10), 15–30 November 2023; Available online: https://ecsa-10.sciforum.net/ .
Eng. Proc. 2023, 58(1), 59; https://doi.org/10.3390/ecsa-10-16204
Published: 15 November 2023
(This article belongs to the Proceedings of The 10th International Electronic Conference on Sensors and Applications)
Abstract
:Low back pain (LBP) is one of the most common musculoskeletal conditions and the leading cause of disability. It is estimated that at least 8 out of 10 people experience low back pain during their lifetime. The purpose of this study was to determine trunk kinematics in individuals with and without non-specific chronic LBP during flexion–extension and hurdle step tests. A total of 90 participants (45 participants with LBP and 45 without LBP), aged between 18 and 50, participated in this study. The wearable inertial sensors were used to capture three-dimensional movements during both trunk flexion–extension and the hurdle step test. Altered trunk kinematics during the flexion–extension and the hurdle step test were observed in individuals with non-specific chronic low back pain.
1. Introduction
Low back pain (LBP) is one of the most common musculoskeletal conditions and the leading cause of disability [1]. It is estimated that 8 out of 10 people experience LBP during their lifetime [1]. Non-specific LBP, where no pathological or anatomical changes [2] are found, accounts for 85 percent of all LBP cases [1]. Muscle stiffness and movement impairment or limitation are the common symptoms of non-specific LBP [1]. Researchers have reported changes in the lumbar lordosis and spinal range of motion (ROM) in persons with LBP when compared with controls [3,4,5]. Zubierer et al. [3] studied the convergence and discriminant validity for lumbar range of motion tests and LBP. Alaa Haj et al. [4] reported on the ROM, average speed, maximum speed, and maximum acceleration of lumbar rotation in the neutral position and full flexion. Ng et al. [5] compared the lumbar kinematics of a flexion–extension and lateral flexion ROM test between persons with LBP and controls. Other researchers have measured lumbar kinematics using a hurdle step test [2,6]. However, few studies have focused on trunk kinematics during both ROM and the hurdle step test using wearable motion capture systems, although these systems have been extensively used in human motion analyses [7,8]. The purpose of this study was to determine trunk kinematics in individuals with and without non-specific chronic LBP during flexion–extension and hurdle step tests.
2. Material and Methods
2.1. Participant Information
A cross-sectional study design was conducted with a total of 90 participants (45 participants with LBP and 45 without LBP), aged between 18 and 50. The study was approved by the Ethics Committee of the Mongolian National University of Medical Sciences (N° 2022\3-7).
2.2. Experimental Procedure
The full-body wearable, Xsens motion capture system (MVN, Xsens Technologies BV, the Netherlands) was used to capture the three-dimensional (3D) movements of the trunk during flexion–extension while standing and during the hurdle step test at a sampling rate of 120 Hz. Each participant performed both movement tasks three times. Trunk flexion–extension was performed in the standing position by bending forward and backward with the knees locked in extension (Figure 1a). In the hurdle step test, participants started in a standing position and stepped over the hurdle (Figure 1b). The height of the hurdle was adjusted to equal the height of the person’s tibial tuberosity [2].
The wearable captain system includes 15 inertial measurement unit (IMU) sensors, which were attached to the head, sternum, pelvis, left/right shoulder, upper- and forearm, upper and lower leg, and foot. With sensors attached, each participant performed trunk flexion–extension and the hurdle step test three times, according to the protocol of previous studies [2]. The trunk joint angles and velocity in the sagittal (flexion–extension), frontal (lateral bending), and transversal (axial rotation) planes were calculated using a relative orientation between pelvis and thorax segments, and averaged for the LBP and control groups [9].
2.3. Statistical Analysis
The statistical analysis of participant characteristics and trunk kinematics was performed using IBM SPSS Statistics Version 25. Mean values and standard deviations for age, weight, height, and gender were calculated using descriptive statistics. Differences in parameters between people with and without non-specific LBP were determined using an age- and weight-adjusted analysis of variance (ANOVA).
3. Results
Table 1 shows the characteristics of the participants. We compared the measurement of trunk range of motion (ROM) and velocity in three planes during the flexion–extension ROM test (Table 2) and the hurdle step test (Table 2) between the LBP and control groups. We found that some trunk kinematics were different between people with and without LBP (Table 2). For instance, during the flexion–extension test, trunk lateral bending and rotation range of motion angles had statistically significant differences between the group with LBP and the control group, as highlighted in red in Table 2. Additionally, during the hurdle step test, there were significant differences in trunk rotation velocity between the group with LBP and the control group.
4. Discussion and Conclusions
In this study, we used a wearable IMU sensor to compare trunk kinematics during flexion–extension and hurdle step tests between LBP and control groups (Table 2). We used flexion–extension ROM to determine the range of motion and velocity of the trunk. During trunk flexion–extension, lateral bending, and rotation, the range of motion angles showed statistically significant differences between the LBP and control groups. Some studies of persons with LBP, using IMU sensor measures, have shown a decreased range of flexion, extension, lateral bending, and axial rotation [9,10,11], and these results are consistent with the results of our current study. The results indicate that trunk kinematic changes in the spine can be evaluated using an IMU sensor in persons with non-specific LBP. In addition, the trunk joint angle and velocity measured during the hurdle step test showed significantly less trunk rotation in the LBP group than in the control group. The hurdle stepping task requires stability and coordination between the hips and torso during the stepping motion. Ko, et al. suggested that patients with chronic LBP lack this stability and coordination [6]. The low score of patients with chronic LBP on the hurdle step task confirms that spine and hip mobility is limited in chronic LBP [12]. In LBP, the movement of the trunk and hips may limit the range of motion velocity of the trunk rotation during functional tasks such as the hurdle step test. The main limitation of the present study is that the subjects in the control group were younger and leaner than those in the LBP group. However, the statistical analysis was adjusted for age and weight. In conclusion, altered trunk kinematics during the flexion–extension and hurdle step test were observed in individuals with non-specific chronic LBP. This result may be useful in further investigations into movement analyses of persons with low back pain and potentially support development of kinematic outcome measures.
Author Contributions
Conceptualization, B.K. and B.D.; methodology, B.K. and B.D.; software, B.K. and B.D.; validation, B.K., B.D. and M.-e.B.; formal analysis, B.K. and B.D.; investigation, B.D.; resources, B.D. and M.-e.B.; data curation, B.D. and M.-e.B.; writing—original draft preparation, B.D.; writing—review and editing, B.K., D.B., M.-e.B. and B.A.; visualization, B.K. and B.D.; supervision, D.B. and B.A.; project administration, B.K. and M.-e.B.; funding acquisition, B.K. All authors have read and agreed to the published version of the manuscript.
Funding
This work was supported by the Mongolian University of Science and Technology (mfund-052022) and the “Mongolia-Japan Engineering Education Development” project (J24C16), Mongolia.
Institutional Review Board Statement
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the Mongolian National University of Medical Sciences (N° 2022\3-7).
Informed Consent Statement
Informed content was obtained from all subjects involved in the study.
Data Availability Statement
Data are contained within the article.
Acknowledgments
The authors would like to thank the team of Biomechanical Research Laboratory, Mongolian University of Science and Technology.
Conflicts of Interest
The authors declare no conflicts of interest.
References
- Disease, G.B.D.; Injury, I.; Prevalence, C. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016, 388, 1545–1602. [Google Scholar] [CrossRef]
- Bayartai, M.E.; Ferreira, P.H.; Pappas, E.; Pinheiro, M.B.; Dambadarjaa, B.; Khuyagbaatar, E.; Sullivan, J. Genetic and environmental effects on lumbar posture, flexibility and motion control in healthy adults. Musculoskelet Sci. Pract. 2020, 50, 102253. [Google Scholar] [CrossRef] [PubMed]
- Zuberbier, O.A.; Kozlowski, A.J.; Hunt, D.G.; Berkowitz, J.; Schultz, I.Z.; Crook, J.M.; Milner, R.A. Analysis of the convergent and discriminant validity of published lumbar flexion, extension, and lateral flexion scores. Spine 2001, 26, E472–E478. [Google Scholar] [CrossRef] [PubMed]
- Haj, A.; Weisman, A.; Masharawi, Y. Lumbar axial rotation kinematics in men with non-specific chronic low back pain. Clin. Biomech. 2019, 61, 192–198. [Google Scholar] [CrossRef] [PubMed]
- Ng, J.K.; Richardson, C.A.; Kippers, V.; Parnianpour, M. Comparison of lumbar range of movement and lumbar lordosis in back pain patients and matched controls. J. Rehabil. Med. 2002, 34, 109–113. [Google Scholar] [CrossRef] [PubMed]
- Ko, M.J.; Noh, K.H.; Kang, M.H.; Oh, J.S. Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects. J. Phys. Ther. Sci. 2016, 28, 2094–2096. [Google Scholar] [CrossRef] [PubMed]
- Khuyagbaatar, B.; Purevsuren, T.; Ganbat, D. Normal Range of Motion of Lower Extremity Joints in Mongolian Subjects. Eng. Proc. 2021, 11, 29. [Google Scholar]
- Tumurbaatar, M.; Khuyagbaatar, B.; Kim, Y.H.; Danaa, G. Kinematic Characteristics of National and College Level Weightlifters during the Snatch Technique Using Wearable Inertial Sensors. Eng. Proc. 2021, 10, 22. [Google Scholar]
- Shojaei, I.; Vazirian, M.; Salt, E.G.; Van Dillen, L.R.; Bazrgari, B. Timing and magnitude of lumbar spine contribution to trunk forward bending and backward return in patients with acute low back pain. J. Biomech. 2017, 53, 71–77. [Google Scholar] [CrossRef] [PubMed]
- Roncarati, A.; McMullen, W. Correlates of low back pain in a general population sample: A multidisciplinary perspective. J. Manip. Physiol. Ther. 1988, 11, 158–164. [Google Scholar]
- Troup, J.D.; Foreman, T.K.; Baxter, C.E.; Brown, D. 1987 Volvo award in clinical sciences. The perception of back pain and the role of psychophysical tests of lifting capacity. Spine 1987, 12, 645–657. [Google Scholar] [CrossRef] [PubMed]
- McGregor, A.H.; McCarthy, I.D.; Doré, C.J.; Hughes, S.P. Quantitative assessment of the motion of the lumbar spine in the low back pain population and the effect of different spinal pathologies of this motion. Eur. Spine J. 1997, 6, 308–315. [Google Scholar] [CrossRef] [PubMed]
Figure 1.
Trunk flexion–extension and hurdle step tests were performed by the participants: (a) from a standing position, bending forward and backward with locked knees. Repeat 3 times; (b) step over the hurdle from a standing position (start on right leg). Repeat 3 times. The height of the hurdle is equal to the height of the person’s tibial tuberosity (5).
Figure 1.
Trunk flexion–extension and hurdle step tests were performed by the participants: (a) from a standing position, bending forward and backward with locked knees. Repeat 3 times; (b) step over the hurdle from a standing position (start on right leg). Repeat 3 times. The height of the hurdle is equal to the height of the person’s tibial tuberosity (5).
Table 1.
Participants’ characteristics.
| Subjects | LBP n = 45 | Control n = 45 |
|---|---|---|
| Age (years) | 33 ± 10.1 | 24.5 ± 8.0 * |
| Height (cm) | 162.9 ± 8.1 | 163 ± 8.1 |
| Weight (kg) | 67.4 ± 16.5 | 59.4 ± 10.2 * |
| Gender (female) | 36 (80%) | 31 (69%) |
* p ≤ 0.05—a significant difference. Mean ± SD.
Table 2.
Comparison of trunk ROM and velocity during Flexion–Extension and Hurdle Step Tests in LBP and control groups.
Table 2.
Comparison of trunk ROM and velocity during Flexion–Extension and Hurdle Step Tests in LBP and control groups.
| Variables | Control (n = 45) | LBP (n = 45) | Differences in ROM | |
|---|---|---|---|---|
| Flexion–Extension Test | Flexion (degree) | 11.3 (1.2) | 7.7 (1.2) | 3.6 (−0.03 to 7.2) |
| Extension (degree) | −14.2 (1.0) | −17.2 (1.0) | −2.9 (−0.2 to 6.1) | |
| Lateral bending (degree) | 12.6 (0.7) | 8.8 (0.7) * | 3.7 (1.5 to 5.9) | |
| Rotation (degree) | 8.2 (0.5) | 6.0 (0.5) * | 2.1 (0.6 to 3.6) | |
| Flexion–extension velocity (m/s) | 0.61 (0.09) | 0.69 (0.09) | −0.07 (−0.3 to 0.2) | |
| Lateral bending velocity (m/s) | 0.2 (0.03) | 0.2 (0.03) | 0.03 (−0.08 to 0.14) | |
| Rotation velocity (m/s) | 0.29 (0.04) | 0.25 (0.04) | 0.03 (−0.08 to 0.16) | |
| Hurdle Step Test | Flexion–extension (degree) | 4.4 (1.0) | 3.5 (1.0) | 0.9 (−2.2 to 4.0) |
| Lateral bending (degree) | 12.0 (1.1) | 12.3 (1.1) | −0.3 (−3.8 to 3.2) | |
| Rotation (degree) | 66.8 (3.2) | 63.7 (3.2) | 3.0 (−6.6 to 12.6) | |
| Flexion–extension velocity (m/s) | 37.2 (3.2) | 41.3 (3.2) | −4.1 (−13.6 to 5.3) | |
| Lateral bending velocity (m/s) | 47.6 (3.4) | 46.3 (3.4) | 1.2 (−5.8 to 11.3) | |
| Rotation velocity (m/s) | 56.6 (3.9) | 40.8 (3.9 *) | 15.7 (4.1 to 27.3) | |
* p ≤ 0.05—significantly different. Mean (standard error). Mean—covariates of age and weight.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
MDPI and ACS Style
Dambadarjaa, B.; Khuyagbaatar, B.; Boldbaatar, D.; Avirmed, B.; Bayartai, M.-e. Changes in Trunk Kinematics in People with Chronic Non-Specific Low Back Pain Using Wearable Inertial Sensors. Eng. Proc. 2023, 58, 59. https://doi.org/10.3390/ecsa-10-16204
AMA Style
Dambadarjaa B, Khuyagbaatar B, Boldbaatar D, Avirmed B, Bayartai M-e. Changes in Trunk Kinematics in People with Chronic Non-Specific Low Back Pain Using Wearable Inertial Sensors. Engineering Proceedings. 2023; 58(1):59. https://doi.org/10.3390/ecsa-10-16204
Chicago/Turabian StyleDambadarjaa, Batlkham, Batbayar Khuyagbaatar, Damdindorj Boldbaatar, Baljinnyam Avirmed, and Munkh-erdene Bayartai. 2023. "Changes in Trunk Kinematics in People with Chronic Non-Specific Low Back Pain Using Wearable Inertial Sensors" Engineering Proceedings 58, no. 1: 59. https://doi.org/10.3390/ecsa-10-16204
