Kaitlyn Armstrong, Chip Wade, Thomas L. Andre, Corbit Franks. The University of Mississippi, Oxford, MS.

BACKGROUND: While low back pain (LBP) is one of the most prevalent causes for visits to a physician’s office and patients with LBP often cannot be given a definitive diagnosis. The purpose of the study was to provide a bending protocol that could be used in both imaging and non-imaging protocols to deduce patient bending variability. METHODS: 16 subjects (21.4 ± 3.3 years; BMI 24.8 ± 2.6) participated in this study. Subjects completed randomized bending trials (untrained, trained, and bolstered). Full-body motion was captured using the Vicon 460 motion measurement system and a Noraxon Axion 8 channel electromyographic system. Analyses were performed to determine the significance between the three conditions in kinematic and EMG parameters. One-way analysis of variance and univariate analyses were conducted to determine the differences between the three testing conditions with significance set at p ≤ 0.01. RESULTS: There were significant differences between the three conditions. The bolstered condition provided optimal results when compared to the untrained and trained protocols. Peak lumbar flexion was significantly higher in the bolstered condition (61o ± 13o) and the trained condition (54o ± 11o) than the untrained condition (42o ± 19o). When comparing the bolstered bending to the trained and untrained bending differences in lumbar flexion, the bolstered bending resulted in significantly greater flexion of (7 o ± 5o, p=0.006) and (19 o ± 9o, p=0.003) respectively. Peak pelvic flexion was significantly lower in the bolstered condition (.3o ± .6o) compared to untrained and trained bending (43 o ± 11o and 41 o ± 13o) respectively. The univariate analyses revealed significant differences between the bolstered bending and the untrained and trained conditions when considering the lumbo-pelvic coordination of (17% ± 6%, p=0.001) and (30% ± 11%, p=0.002) respectively. CONCLUSIONS: The bolstered condition offered optimal bending results to elicit lumbar bending. The trained condition produced greater isolation and more lumbar movement when compared to the untrained bend, while the bolstered bending produced the most repeatable bending profile. The bolstering system is expensive and increases the treatment time. The results of the study offer support for the implementation of the trained bending protocol to elicit more effective lumbar flexion/extension testing methodologies when bolstering is not feasible.

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