Analyzing signatures from endurance runners with lower back pain: a cross-sectional case-control study

Abstract

Background:

Lower back pain (LBP) is a condition that has been poorly studied among runners, and it is unclear what biomechanical characteristics could be addressed in gait retraining to alleviate the pain.

Research question:

How does the running biomechanics differ between healthy individuals and those with race-related lower back pain?

Methods:

This was a comparative case-control study design of community runners: race-related lower back pain (n = 52) and healthy controls (n = 52). All runners completed race history forms and underwent a three-dimensional gait analysis. Kinematic data was collected using a motion capture system and normalized to a gait cycle while the participants ran on a level slope at a self-selected speed on a instrumented treadmill. Current running volume, temporal-spatial characteristics, kinetic, and kinematic features were compared between the groups.

Results:

The LBP group had 39.5% less weekly distance and 15.4% less current training for a race (all p<0.05). Runners with lower back pain exhibited lower cadence (166±10 steps/min vs. 171±9 steps/min; p=.05), greater lateral displacement of the center of gravity (1.4±0.5 cm vs. 1.2 ±0.3 cm; p=.044), and higher stride width variability (1.3±0.4 cm vs. 1.0 ± 0.04 cm; p=0.008). Runners with lower back pain had a higher average vertical loading rate (VALR) 67.7 ± 22.2 body weight (BW)/s vs. 62.2 ± 21.5 BW/s; p=0.022) and higher joint moments (N*m/(kg*m)) at the knee in the sagittal plane (2.13±0.50 vs. 1.87±0.56; p <.001), frontal plane (1.44±0.39 vs. 1.29±0.29; p=.013), and at the hip in the frontal plane (2.04±0.51 vs. 1.84±0.41; p=0.024). No differences were found between the groups in joint excursions of the pelvis, hip, knee, and ankle in any plane of movement during a typical gait cycle.

Significance:

These collective movement signatures may reflect challenges with movement control and VALR in the presence of back pain. Cadence training to increase step speed, along with activation of core/hip muscles, may be an important strategy to reduce movement variability, impact loading rate, and running-related pain symptoms.

Keywords:

Biomechanics; Ground reaction force; Low back pain; Running.

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