Effect of Obesity and Low Back Pain

7/27/2019 Effect of Obesity and Low Back Pain

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Journal PresentationDwi Kartika Sari

030.07.073


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Background The relationship between obesity and cLBP (chronic

low back pain) remains unsupported by anobjective measurement of the mechanical behavior

of the spine and its morphology in obese subjects

Purpose To assess the posture and function of the spine

during standing, flexion and lateral bending inobese subjects with and without cLBP and toinvestigate the role of obesity in cLBP.


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Study design Cross sectional

Patient sample Thirteen obese subjects, thirteen obese subjects with

cLBP, and eleven healthy subjects

Outcome measure Evaluated the outcome in terms of angles at the initial

standing position (START) and at maximum forwardflexion (MAX), and also the range of motion (ROM)between START and MAX.


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Methods Optoelectronic system and passive retroreflective

markers that applied on the trunk. To analyzekinematics and define angles of clinical interest,biomechanical model was developed.

Results Obesity was characterized by a generally reduced ROM

of the spine, due to a reduced mobility at both pelvicand thoracic level. Obesity with cLBP is associated withan increased lumbar lordosis. In lateral bending, obesitywith cLBP is associated with a reduced ROM of thelumbar and thoracic spine, whereas obesity on its ownappears to affect only the thoracic curve.


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Conclusions Obese individuals with cLBP showed higher degree of

spinal impairment when compared to those withoutcLBP.

The observed obesity-related thoracic stiffness maycharacterize this sub-group of patients, even ifprospective studies should be carried out to verify thishypothesis.


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Obesity = major health problem

associated with musculoskeletal

disorders

OA prevalence in obese patients =

34%

The reported prevalence of LBP was

22% on 5724 obese adults 60

years/older

Aim : to propose a quantitative

protocol to describe and quantify

the functional mobility of the spine

during flexion and lateral bending

in order to investigate the

relationship between obesity and

LBP.


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37 female adults

Group O13 obese patients

without LBP

Group cLbp

13 obese patients

with non-specific

cLBP

Group C 11 healthy women

Data were acquired with a 6-camera optoelectronic motionanalysis system


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Female

same gynoidmass distribution &prevalence in women isgreater

Not under any treatment

cLBP patients weredefined according toclinical examination &duration of pain

Xray was performed toexclude the secondary

cLBP Written informed

consent


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Tasks : forward flexion & lateral binding bothsides.

Subjects were instructed to perform the testcomfortably at their own preferred speed withfeet apart at shoulder width.

Each movement was repeated three times andthe best acquisition was chosen for further

analysis.


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Three-dimensional data from theoptoelectronic system were processed.

The above mentioned angles were evaluatedat the initial standing position (START) and atmaximum forward flexion (MAX).

The range of motion (ROM) between STARTand MAX was also computed.


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Compared to C, flexion ROM was reduced in O and cLBP. The angle related to lordosis was significantly increased in

cLBP in the start position as compared to C and O. The angle related to kyphosis was similar in the three

groups in START, but ROM was significantly reduced in Oand cLBP.

Lumbar movement in cLBP was significantly reduced inMAX when compared to O as well as to C.

In START, statistically significant difference was found onlybetween cLBP and C.

The thoracic movement was significantly reduced in O andcLBP as compared to C, not only in MAX but also in ROM.


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Lumbar movement in cLBP was significantlyreduced in MAX when compared to O as wellas to C.

In START, statistically significant differencewas found only between cLBP and C.

The thoracic movement was significantlyreduced in O and cLBP as compared to C, not

only in MAX but also in ROM.


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cLBP showed a significant reduction in lateralbending and a reduced lumbar ROM ascompared to O and C.

No differences among groups were observedin lumbar movement and in pelvic obliquity.


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The thoracic curve was statistically differentamong the three groups, with cLBP yieldingthe worst results.

cLBP also showed a significant reduction inthoracic and shoulder movements ascompared to O and C.


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No differences between cLBP and O has beenfound in terms of age and BMI (p = NS) while, asexpected, C was statistically different from othergroups in terms of BMI.

The analysis has revealed biomechanicaldifferences in spinal mobility between C and Ounder static and dynamic conditions.

Prospective studies are needed to prove a cause-

effect relationship.


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Postural analysis shows significant differences atlumbar and pelvic level among groups.

In line with Gilleard, we observed an increasedlumbar lordosis in obese patients with cLBP.

Postural changes may therefore cause aninsufficient muscle force output, but also otherfactors, such as inappropriate neuromuscularactivation and muscular fatigue, may contribute

to a reduced spinal stability during full flexion.


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During forward flexion, the thoracic ROM wassignificantly lower in O and significantly lower incLBP as compared to C, while lumbar ROMremained similar among the three groups.

Due to thoracic stiffness, forward flexion in Oand particularly in cLBP appears to be performedmainly by the lumbar spine, which is mostfrequently involved in pain syndromes.


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The main limitations of our study include: The small sample size, due to the time-consuming

tests used;

Inclusion of females only, to reduce the cross-

gender variability of fat mass distribution; Transversal design, to develop hypotheses to be

proven in future longitudinal studies;

Absence of a not-obese cLBP cohort of patients


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Our data show in obese patients static and dynamicadaptations in the kinematics of the spine: understatic conditions, obesity seems correlated to anincreased anterior pelvic tilt; under dynamicconditions to impaired mobility of the thoracic spine.

Obesity with cLBP is associated with higher spinalimpairment than obesity without cLBP, and anincreased lumbar lordosis.

According to our study, even if no cause-effectrelationships can be drawn, rehabilitativeinterventions in obese patients should include

strengthening of the lumbar and abdominal musclesas well as mobility exercises for the thoracic spineand pelvis.


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Thank You

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Effect of Obesity and Low Back Pain

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