The effects of differences on sagittal kinematics and muscle coordination during step up and step down in patients with spinal stenosis

Abstract

BACKGROUND AND OBJECTIVE:

Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects swing limb angles and stance limb muscle activities. Therefore, we investigated the effects of differences in step up (SU) and step down (SD) tasks on the kinematics of the trunk and swing limb as well as stance limb muscle coordination in patients with LSS.

METHODS:

Nine elderly female patients diagnosed with LSS were recruited for this study. The sagittal kinematics of the trunk and swing limb and isolated contraction ratio of the gluteus medius (GMed) and vastus lateralis (VL) during SU and SD tasks were measured using a motion analysis system and surface electromyography system.

RESULTS:

Thoracic (17.71 ${}^{\circ }$ $\pm$ 7.77 ${}^{\circ }$ ) and spine angles (13.64 ${}^{\circ }$ $\pm$ 11.34 ${}^{\circ }$ ) as well as swing hip (48.48 ${}^{\circ }$ $\pm$ 12.76 ${}^{\circ }$ ) and pelvic angles (7.52 ${}^{\circ }$ $\pm$ 10.33 ${}^{\circ }$ ) were significantly greater during SU than SD (10.14 ${}^{\circ }$ $\pm$ 8.41 ${}^{\circ }$ , 10.03 ${}^{\circ }$ $\pm$ 11.03 ${}^{\circ }$ , 29.42 ${}^{\circ }$ $\pm$ 10.57 ${}^{\circ }$ , 3.21 ${}^{\circ }$ $\pm$ 10.11 ${}^{\circ }$ , all $P<$ 0.05, respectively). The isolated contraction ratio of the GMed of the stance limb (34.12% $\pm$ 13.28%) was significantly higher during SU than during SD (26.65% $\pm$ 10.02%), whereas that of the VL of the stance limb (65.88% $\pm$ 13.28%) was significantly lower during SU than during SD (73.35% $\pm$ 10.02%, $P=$ 0.011 for both comparisons).

CONCLUSIONS:

Patients with LSS demonstrated trunk compensatory mechanisms to address swing hip and knee angles. Trunk position affected pelvic limb muscle coordination in the standing support limb. These findings demonstrate that SD are more challenging than SU for patients with LSS, possibly due to reduced ability to generate adequate leg extensor muscular output to safely control the motion of the body’s center of mass. Therefore, trunk positions must be considered when patients with LSS undergo rehabilitation programs, particularly those involving SD or descending stairs, so that healthcare professionals can better assist patients with LSS. In addition, this study provides a background for further studies.