A history of low back pain affects pelvis and trunk coordination during a sustained manual materials handling task.

PURPOSE: The purpose of this study was to compare the coordination between the trunk and the pelvis during a sustained asymmetric repetitive lifting task between a group with a history of low back pain (LBP; HBP) and a group with no history of LBP (NBP). METHODS: Volunteers lifted a 11-kg box from ankle height in front to a shelf 45° off-center at waist height, and lowered it to the start position at 12 cycles/min for 10 min. Lifting side was alternated during the trial. Continuous relative phase was used to calculate coordination between the pelvis and trunk rotation at the beginning (Min 1), middle (Min 5), and end of the bout (Min 9). RESULTS: While there were no main effects for group, a significant interaction between time and group indicated that, in the frontal plane, the NBP group coordination was more anti-phase toward the end of the bout, with no such differences for the HBP group. Analysis of sagittal-axial (bend and twist) coordination revealed the HBP group coordination was more in-phase at the end of the bout over the entire cycle and for the lifting phase alone, with no such differences for the NBP group. CONCLUSION: Differences between groups demonstrate residual consequences of LBP in an occupational scenario, even though the HBP group was pain-free for >6 months prior to data collection. More in-phase coordination in the HBP group may represent a coordination pattern analogous to "guarded gait" which has been observed in other studies, and may lend insight as to why these individuals are at increased risk for re-injury.

Characterization of Foot-Strike Patterns: Lack of an Association With Injuries or Performance in Soldiers.

OBJECTIVES: Characterize the distribution of foot-strike (FS) patterns in U.S. Army Soldiers and determine if FS patterns are related to self-reported running injuries and performance. METHODS: 341 male Soldiers from a U.S. Army Combined Arms Battalion ran at their training pace for 100 meters, and FSs were recorded in the sagittal plane. Participants also completed a survey related to training habits, injury history, and run times. Two researchers classified FS patterns as heel strike (HS) or nonheel strike (NHS, combination of midfoot strike and forefoot strike patterns). Two clinicians classified the musculoskeletal injuries as acute or overuse. The relationship of FS type with two-mile run time and running-related injury was analyzed (p ≤ 0.05). RESULTS: The Soldiers predominately landed with an HS (87%) and only 13% were characterized as NHS. Running-related injury was similar between HS (50.3%) and NHS (55.6%) patterns (p = 0.51). There was no difference (p = 0.14) between overuse injury rates between an HS pattern (31.8%) and an NHS pattern (31.0%). Two-mile run times were also similar, with both groups averaging 14:48 minutes. CONCLUSION: Soldiers were mostly heel strikers (87%) in this U.S. Army Combined Arms Battalion. Neither FS pattern was advantageous for increased performance or decreased incidence of running-related injury.

Lower extremity biomechanical changes associated with symmetrical torso loading during simulated marching.

The dose-response relationship between biomechanical variables and the magnitude of external loads is unclear. The use of different load distributions (e.g., pack types) may confound results because of changes in torso center of mass. Therefore, we examined the relationship between load magnitude and sagittal plane lower extremity mechanics of Soldiers walking with two symmetrically distributed loads. Fourteen Soldiers marched on a force-sensing treadmill at 1.34 m/s for 10 minutes with no load (BW_00) and while wearing vest-borne loads of 15 kg (BW_15) and 55 kg (BW_55). The effects of the loads on sagittal plane joint angles and moments were compared using 1-way repeated measures analyses of variance. Compared with BW_00, knee extension moment increased with the 15- and the 55-kg loads (both p < 0.003), confirming previously reported load-related biomechanical responses. Knee moment increases during early stance appeared to be the primary means by which the lower extremity counteracted BW_15 during early stance; in contrast, hip extensors and ankle dorsiflexors appeared to be the primary muscular efforts responsible for propulsion during late stance. Findings elucidated the effects of load magnitude on lower extremity mechanics without postural changes that result from pack-related shifts in torso center of mass.

Lower extremity mechanics during marching at three different cadences for 60 minutes.

During group marches, soldiers must walk in step with one another at the same imposed cadence. The literature suggests that shorter trainees may be more susceptible to injury due to overstriding that can occur when taller recruits dictate marching cadence. This study assessed the effects of fixed cadence simulated marching at cadences above and below preferred step rate (PSR) on lower extremity joint mechanics in individuals who were unaccustomed to marching. During three separate visits, 13 volunteers walked with a 20 kg load on a force-sensing treadmill at self-selected PSR, PSR+15% (shorter strides), and PSR-15% (longer strides) at 1.3 m/s for 60 min. Two-way RM ANOVAs (cadence by time) were performed during the stance phase. Ranges of motion and anteroposterior ground reaction force increased significantly as cadence decreased (P < .03). Knee extension moment increased slightly when step rate decreased from PSR+15% (shortest strides, 0.85 ± 0.2 N m/kg) to PSR (0.87 ± 0.3 N m/kg, 3% increase); however, this increase was substantially greater (20% increase) when cadence was decreased from PSR to PSR-15% (longest strides, 1.09 ± 0.3 N m/kg). Our results indicate that overstriding during fixed-cadence marching is a factor that can substantially increase mechanical stress on lower extremity joints.

A history of low back pain affects pelvis and trunk mechanics during a sustained lift/lower task.

This study compared three-dimensional trunk and pelvis range of motion (ROM) during a sustained asymmetric box lift/lower task between a group with a history of low back pain (HBP, n = 9) and a group with no history of low back pain (NBP, n = 9). Participants lifted an 11-kg box for 10 min at 12 cycles/min from ankle height in front to shelves 45 deg off-centre at waist height. Kinematic data were collected at the beginning (min1), middle (min5) and end of the bout (min9). Two-way analyses of variance were performed for all variables. Pelvis and trunk transverse ROM were similar at min1. By min9, HBP group did not change (31.9 ± 9 deg); however, ROM decreased in NBP group (21.6 ± 6 deg, p < 0.05). Therefore, despite no current pain, the HBP group demonstrated protective lifting mechanics compared to controls. Also discussed are implications for studying lifting paradigms at sub-maximal effort over longer periods of time. PRACTITIONER SUMMARY: Differences between groups over time demonstrate residual consequences of low back pain (LBP) in a manual materials handling scenario. Individuals with a history of LBP (pain free for 6 months) demonstrated more conservative lifting mechanics towards the end of the bout compared to controls with no history of LBP.

Hypohydration does not alter standing balance.

We examined the effect of body water deficits on standing balance and sought to determine if plasma hyperosmolality (P(osm)) and/or volume reduction (%ΔV(plasma)) exerted independent effects. Nine healthy volunteers completed three experimental trials which consisted of a euhydration (EUH) balance test, a water deficit session and a hypohydration (HYP) balance test. Hypohydration was achieved both by exercise-heat stress to 3% and 5% body mass loss (BML), and by a diuretic to 3% BML. Standing balance was assessed during quiet standing on a force platform with eyes open and closed. With eyes closed, hypohydration significantly decreased medial-lateral sway path and velocity by 13% (both p < .040). However, 95% confidence intervals for the mean difference between EUH and HYP were all within the coefficient of variation of EUH measures, indicating limited practical importance. Neither V(plasma) loss nor P(osm) increases were associated with changes in balance. We concluded that standing balance was not altered by hypohydration.