Functional impairment as a predictor of spine loading.

STUDY DESIGN Spine loadings during a variety of lifting exertions were compared with individual torso kinematic abilities. Relationships were evaluated between these measures. OBJECTIVE To determine if trunk kinematic status (functional impairment) is indicative of spine loading increases in patients with low back pain (LBP) compared to asymptomatic individuals. SUMMARY OF BACKGROUND DATA Recurrent LBP is a common and costly problem that may be related to increased spine loads in those individuals with LBP. Previous studies suggest that patients with LBP had greater loading than their asymptomatic counterparts when performing work. However, we know little about how to identify when a patient with LBP can resume lifting tasks without having exaggerated spine loading. METHODS Sixty-two patients with LBP and 61 who were asymptomatic were evaluated for signs of kinematic compromise (i.e., inability to generate normal trunk kinematic patterns) during a prelift test. All subjects were then asked to perform a variety of lifting exertions that varied in lift origin (region), lift asymmetry position, and weight lifted. An electromyography-assisted model was used to evaluate spine loading in each subject during the lifting exertions. Statistical models were used to assess the relationship between kinematic compromise and spine loading. RESULTS Patients with LBP had greater spine loading as well as greater kinematic compromise. The degree of kinematic compromise was related to the degree of spine loading increases in those individuals with LBP. A statistical model was developed that was able to describe 87% of the variability in compression, 61% in anteroposterior shear, and 65% in lateral shear. CONCLUSIONS Those patients with greater kinematic compromise used higher levels of antagonistic muscle coactivation that not only reduced trunk motion but also resulted in increases in spine loading. Given the degree of kinematic compromise and the lifting task conditions, a method has been devised to predict the increase in spine loading above and beyond that of an asymptomatic individual when performing typical materials handling tasks.