Walking and running with non-specific chronic low back pain: what about the lumbar lordosis angle?

Non-specific chronic low back pain (NSCLBP) is a major health problem, affecting about one fifth of the population worldwide. To avoid further pain or injury, patients with NSCLBP seem to adopt a stiffer movement pattern during everyday living activities. However, it remains unknown how NSCLBP affects the lumbar lordosis angle (LLA) during repetitive activities such as walking or running. This pilot study therefore aimed at exploring possible NSCLBP-related alterations in LLAs during walking and running by focusing on discrete parameters as well as continuous data. Thirteen patients with NSCLBP and 20 healthy pain-free controls were enrolled and underwent a full-body movement analysis involving various everyday living activities such as standing, walking and running. LLAs were derived from markers placed on the spinous processes of the vertebrae L1-L5 and S1. To quantify possible group differences in discrete (average and range of motion (ROM)) and continuous LLAs, we calculated effect sizes (Hedges' g). Patients with NSCLBP showed reduced average LLAs during standing, walking and running (g=-0.44 to -0.68) and smaller LLA-ROM during walking (g=0.60). Analyses of continuous data indicated the largest group differences occurring around 25% (g=-0.80) and 70% (g=-0.75) of the walking and 25% (g=-0.57) and 75% (g=-0.55) of the running cycle. Furthermore, patients indicated a reversed movement pattern during running, with increasing instead of a decreasing LLAs after foot strike. This study provides evidence that NSCLBP appears to affect LLAs during walking and running. These results can be used as a basis for future large-scale investigations involving hypothesis testing.