The relationship between lumbar spine kinematics during gait and low-back pain in transfemoral amputees.

OBJECTIVE

Low-back pain is an important cause of secondary disability in transfemoral amputees. The primary aim of our study is to assess the differences in lumbar spine kinematics during gait between transfemoral amputees with and without low-back pain.

DESIGN

Lumbar spine kinematics in three planes were measured when the subjects walked in a motion analysis laboratory. Nine transfemoral amputees with low-back pain, eight transfemoral amputees without low-back pain, and six healthy, nonamputee subjects participated.

RESULTS

The Amputee Pain and Amputee No Pain groups were essentially the same in terms of all demographic and potentially confounding variable measures. Transfemoral amputees with low-back pain showed greater transverse plane rotational excursion in their lumbar spine during walking when compared with transfemoral amputees without low-back pain (P = 0.029; effect size = 1.03). There were no significant differences in sagittal or coronal plane lumbar spine excursions during walking between these two groups.

CONCLUSIONS

Although our study design does not allow for proving causation, increased transverse plane rotation has been associated with intervertebral disc degeneration, suggesting that increased transverse plane rotation secondary to walking with a prosthetic limb may be a causative factor in the etiology of low-back pain in transfemoral amputees. Identifying differences in lumbar motion can lead to potential preventative and therapeutic intervention strategies.