Stepping over an obstacle in patients with lumbar spinal stenosis: Trunk and lower extremities of kinematic and muscle activation normalized by double limb support. A preliminary study

Abstract

BACKGROUND:

Patients with LSS tend to adopt a flexed lumbar posture and trunk position, particularly when stepping over an obstacle, as this activity alters the biomechanical demands placed on the trunk and lower extremities.

OBJECTIVE:

To investigate the effects of lumbar spinal stenosis (LSS) on patients’ trunk and lower-extremity kinematics, and on activities involving the gluteus medius (GMed) and vastus lateralis (VL).

METHODS:

All participants (9 older adult patients with LSS and 11 control subjects) were required to negotiate an obstacle while walking. Trunk and lower-extremity kinematic data and GMed and VL activities were recorded using a synchronized 3D motion capture system and surface electromyography.

RESULTS:

The thoracic (12.01 ${}^{\circ }$ $\pm$ 8.82 ${}^{\circ }$ and 16.45 ${}^{\circ }$ $\pm$ 10.80 ${}^{\circ }$ ) and spinal (9.92 ${}^{\circ }$ $\pm$ 14.03 ${}^{\circ }$ and 5.99 ${}^{\circ }$ $\pm$ 15.94 ${}^{\circ }$ ) flexion angles of the leading and trailing swing limbs were higher, and the pelvic anterior tilting angle (2.37 ${}^{\circ }$ $\pm$ 7.76 ${}^{\circ }$ and 10.38 ${}^{\circ }$ $\pm$ 8.07 ${}^{\circ }$ ) was lower in the LSS group than in the control group ( $p<$ 0.05). With the exception of toe-off and normalized GMed activities in the contralateral leading limb ( $p>$ 0.05), all GMed (256.73 $\pm$ 112.22%, 174.00 $\pm$ 75.79%, and 270.57 $\pm$ 114.45%, respectively) and VL (208.98 $\pm$ 124.81%, 182.97 $\pm$ 93.23%, 283.91 $\pm$ 154.71%, and 394.42 $\pm$ 108.94%, respectively) activities of the contralateral leading and trailing swing limb (heel-strike and toe-off normalized activities) were significantly higher in the LSS group than in the control group ( $p<$ 0.05).

CONCLUSIONS:

Patients with LSS exhibited trunk-flexed postures when stepping over an obstacle, and these trunk alignments placed higher demands on the GMed and VL activities normalized by double-limb support during joint loading in the single-leg stance. These findings support clinical recommendations for regulating the physical activity of obstacle negotiation that may be beneficial in the management of patients with LSS.