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

doi:10.1016/j.jbiomech.2019.109316

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

Biomedical Engineering

Research output: Contribution to journal › Article › peer-review

2 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 language	English
Article number	109316
Journal	Journal of Biomechanics
Volume	95
DOIs	https://doi.org/10.1016/j.jbiomech.2019.109316
State	Published - Oct 11 2019

Bibliographical note

Publisher Copyright:
© 2019

Funding

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. 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.

Funders	Funder number
Office of the Assistant Secretary of Defense for Health Affairs
NIH NICHD
Office of the Chief
U.S. Departments of the Army
U.S. Government
U.S. Department of Defense
NIH National Institute of Child Health and Human Development National Center for Medical Rehabilitation Research	R03HD086512
Henry M. Jackson Foundation
Office of the Assistant Secretary for Health	81XWH-14-2-0144
National Center for Medical Rehabilitation Research
Uniformed Services University of the Health Sciences

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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10.1016/j.jbiomech.2019.109316

Cite this

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

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.",

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AU - Acasio, Julian C.

AU - Shojaei, Iman

AU - Banerjee, Rajit

AU - Dearth, Christopher L.

AU - Bazrgari, Babak

AU - Hendershot, Brad D.

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N2 - 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.

AB - 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.

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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