Trunk-Pelvis motions and spinal loads during upslope and downslope walking among persons with transfemoral amputation

Julian C. Acasio, Iman Shojaei, Rajit Banerjee, Christopher L. Dearth, Babak Bazrgari, Brad D. Hendershot

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Larger trunk and pelvic motions in persons with (vs. without) lower limb amputation during activities of daily living (ADLs) adversely affect the mechanical demands on the lower back. Building on evidence that such altered motions result in larger spinal loads during level-ground walking, here we characterize trunk-pelvic motions, trunk muscle forces, and resultant spinal loads among sixteen males with unilateral, transfemoral amputation (TFA) walking at a self-selected speed both up (“upslope”; 1.06 ± 0.14 m/s) and down (“downslope”; 0.98 ± 0.20 m/s) a 10-degree ramp. Tri-planar trunk and pelvic motions were obtained (and ranges-of-motion [ROM] computed) as inputs for a non-linear finite element model of the spine to estimate global and local muscle (i.e., trunk movers and stabilizers, respectively) forces, and resultant spinal loads. Sagittal- (p = 0.001), frontal- (p = 0.004), and transverse-plane (p < 0.001) trunk ROM, and peak mediolateral shear (p = 0.011) and local muscle forces (p = 0.010) were larger (respectively 45, 35, 98, 70, and 11%) in upslope vs. downslope walking. Peak anteroposterior shear (p = 0.33), compression (p = 0.28), and global muscle (p = 0.35) forces were similar between inclinations. Compared to previous reports of persons with TFA walking on level ground, 5–60% larger anteroposterior and mediolateral shear observed here (despite ∼0.25 m/s slower walking speeds) suggest greater mechanical demands on the low back in sloped walking, particularly upslope. Continued characterization of trunk motions and spinal loads during ADLs support the notion that repeated exposures to these larger-than-normal (i.e., vs. level-ground walking in TFA and uninjured cohorts) spinal loads contribute to an increased risk for low back injury following lower limb amputation.

Original languageEnglish
Article number109316
JournalJournal of Biomechanics
Volume95
DOIs
StatePublished - Oct 11 2019

Bibliographical note

Funding Information:
This work was supported, in part, by an award (5R03HD086512-02) from the National Center for Medical Rehabilitation Research (NIH-NICHD) and the Office of the Assistant Secretary of Defense for Health Affairs, through the Peer Reviewed Orthopaedic Research Program (award #W81XWH-14-2-0144). The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the authors, Department of Defense, or any component agency. The views expressed in this manuscript are those of the authors, and do not reflect the views, opinions, or policies of the Uniformed Services University, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. the U.S. Departments of the Army/Navy/Air Force, Defense, nor the U.S. Government.

Funding Information:
This work was supported, in part, by an award ( 5R03HD086512-02 ) from the National Center for Medical Rehabilitation Research (NIH-NICHD) and the Office of the Assistant Secretary of Defense for Health Affairs, through the Peer Reviewed Orthopaedic Research Program (award #W81XWH-14-2-0144 ). The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the authors, Department of Defense, or any component agency. The views expressed in this manuscript are those of the authors, and do not reflect the views, opinions, or policies of the Uniformed Services University, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the U.S. Departments of the Army/Navy/Air Force, Defense, nor the U.S. Government.

Publisher Copyright:
© 2019

Keywords

  • Biomechanics
  • Extremity trauma
  • Finite element analysis
  • Limb loss
  • Low back pain

ASJC Scopus subject areas

  • Biophysics
  • Biomedical Engineering
  • Orthopedics and Sports Medicine
  • Rehabilitation

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