TY - THES A1 - Müller, Juliane T1 - Trunk loading and back pain T1 - Rumpfbelastungen und Rückenschmerzen BT - three-dimensional motion analysis and evaluation of neuromuscular reflex activity in response to sudden and continuous loading BT - dreidimensionale Bewegungsanalyse und Erfassung der neuromuskulären Aktivität des Rumpfes als Antwort auf plötzliche und kontinuierliche Belastungen N2 - An essential function of the trunk is the compensation of external forces and loads in order to guarantee stability. Stabilising the trunk during sudden, repetitive loading in everyday tasks, as well as during performance is important in order to protect against injury. Hence, reduced trunk stability is accepted as a risk factor for the development of back pain (BP). An altered activity pattern including extended response and activation times as well as increased co-contraction of the trunk muscles as well as a reduced range of motion and increased movement variability of the trunk are evident in back pain patients (BPP). These differences to healthy controls (H) have been evaluated primarily in quasi-static test situations involving isolated loading directly to the trunk. Nevertheless, transferability to everyday, dynamic situations is under debate. Therefore, the aim of this project is to analyse 3-dimensional motion and neuromuscular reflex activity of the trunk as response to dynamic trunk loading in healthy (H) and back pain patients (BPP). A measurement tool was developed to assess trunk stability, consisting of dynamic test situations. During these tests, loading of the trunk is generated by the upper and lower limbs with and without additional perturbation. Therefore, lifting of objects and stumbling while walking are adequate represents. With the help of a 12-lead EMG, neuromuscular activity of the muscles encompassing the trunk was assessed. In addition, three-dimensional trunk motion was analysed using a newly developed multi-segmental trunk model. The set-up was checked for reproducibility as well as validity. Afterwards, the defined measurement set-up was applied to assess trunk stability in comparisons of healthy and back pain patients. Clinically acceptable to excellent reliability could be shown for the methods (EMG/kinematics) used in the test situations. No changes in trunk motion pattern could be observed in healthy adults during continuous loading (lifting of objects) of different weights. In contrast, sudden loading of the trunk through perturbations to the lower limbs during walking led to an increased neuromuscular activity and ROM of the trunk. Moreover, BPP showed a delayed muscle response time and extended duration until maximum neuromuscular activity in response to sudden walking perturbations compared to healthy controls. In addition, a reduced lateral flexion of the trunk during perturbation could be shown in BPP. It is concluded that perturbed gait seems suitable to provoke higher demands on trunk stability in adults. The altered neuromuscular and kinematic compensation pattern in back pain patients (BPP) can be interpreted as increased spine loading and reduced trunk stability in patients. Therefore, this novel assessment of trunk stability is suitable to identify deficits in BPP. Assignment of affected BPP to therapy interventions with focus on stabilisation of the trunk aiming to improve neuromuscular control in dynamic situations is implied. Hence, sensorimotor training (SMT) to enhance trunk stability and compensation of unexpected sudden loading should be preferred. N2 - Eine ausgeprägte Rumpfstabilität gilt als vorteilhaft, um den Rumpf bei repetitiven und plötzlich auftretenden hohen Lasten sowohl in Alltagssituationen, am Arbeitsplatz als auch während Training- oder Wettkampfbelastungen im Sport zu stabilisieren und vor Beschwerden bzw. Verletzungen zu schützen. Eine reduzierte Rumpfstabilität wird daher als Risikofaktor für die Entwicklung von Rückenschmerzen angenommen. Eine veränderte Aktivität (verlängerte Reaktionszeit, verlängerte Aktivierungszeiten, erhöhte Ko-Kontraktion) der rumpfumgreifenden Muskulatur sowie ein reduziertes Bewegungsausmaß und eine erhöhte -variabilität des Rumpfes bei Rückenschmerzpatienten sind evident. Diese Unterschiede sind hauptsächlich in quasi-statischen Belastungssituationen mit isolierter Lasteinwirkung direkt am Rumpf nachgewiesen. Eine Übertragbarkeit auf alltagsnahe und dynamische Belastungssituationen ist jedoch kritisch zu hinterfragen. Ziel des Dissertationsprojektes ist die Entwicklung und Validierung eines Diagnostiktools zur Erhebung der Rumpfstabilität in dynamischen Belastungssituationen bei Gesunden und Rückenschmerzpatienten. Für die Erfassung der Rumpfstabilität wurde ein Mess-Verfahren bestehend aus dynamischen Belastungssituationen, in denen die Lasten über die Extremitäten generiert werden (Heben von Lasten, Perturbation im Gang), mit und ohne Perturbation entwickelt. Mit Hilfe eines 12-Kanal-EMGs wurde die neuromuskuläre Aktivität der rumpfumgreifenden Muskulatur erfasst. Zusätzlich wurde die 3-dimensonale Rumpfbewegung über ein neu entwickeltes multi-segmentales Rückenmodell analysiert. Dieses Methodensetup wurde auf Reproduzierbarkeit sowie Validität überprüft. Im Anschluss erfolgte eine Anwendung des definierten Diagnostiktools zur Erfassung der Rumpfstabilität im Vergleich von Probanden mit und ohne Rückenschmerzen. Eine klinisch akzeptable bis hervorragende Reliabilität konnte für die verwendeten Messvariablen (EMG/Kinematik) in den beschriebenen Belastungssituationen (Heben/Gang mit Perturbation) nachgewiesen werden. Gesunde Erwachsene zeigen bei einer kontinuierlichen Belastung des Rumpfes mit unterschiedlichen Gewichten (Heben von Lasten) keine Veränderung der Rumpfbewegung. Die plötzliche Belastung des Rumpfes durch Hinzunahme von Perturbationen der unteren Extremitäten im Gang konnte dagegen bei gesunden Probanden eine messbare Auslenkung des Rumpfes auf kinematischer als auch neuromuskulärer Ebene hervorrufen. Rückenschmerzpatienten zeigten ein verändertes neuromuskuläres und kinematisches Kompensationsmuster bei externen Perturbationen im Gang im Vergleich zu Gesunden. Dies ist charakterisiert durch eine verzögerte Reaktionszeit sowie verlängerte Dauer zum Erreichen der maximalen neuromuskulären Aktivität in Kombination mit einer reduzierten Lateralflexion des Rumpfes während Perturbation. Die gewählte Testsituation - Perturbation im Gang - scheint, trotz Applikation der Perturbation über die Extremitäten und fehlender Fixierung des Beckens, geeignet zur Provokation erhöhter Anforderungen an die Stabilisierung des Rumpfes bei erwachsenen Probanden. Das veränderte neuromuskuläre und kinematische Kompensationsmuster bei Rückenschmerzpatienten kann als Surrogat einer erhöhten Belastung sowie einer reduzierten Rumpfstabilität bei Patienten bewertet werden. Das neu entwickelte Verfahren zur Erfassung der Rumpfstabilität ist geeignet, um Defizite bei Rückenschmerzpatienten zu identifizieren und folglich individuelle Zuordnungen zu Trainingsmaßnahmen vorzunehmen. Der Fokus in der Prävention bzw. Therapie von Rückenschmerzen sollte dem Folgend auf der Stabilisierung des Rumpfes mit dem Ziel der Verbesserung der neuromuskulären Kontrolle des Rumpfes in dynamischen Situationen liegen. Ein sensomotorischer Trainingsansatz (SMT) zur Optimierung der Rumpfstabilität und Kompensationsfähigkeit von unerwarteten externen Lasten ist zu präferieren. KW - electromyography KW - trunk kinematics KW - spine KW - Wirbelsäule KW - Elektromyographie KW - Rumpfkinematik Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-102428 ER - TY - GEN A1 - Müller, Steffen A1 - Müller, Juliane A1 - Stoll, Josefine A1 - Prieske, Olaf A1 - Cassel, Michael A1 - Mayer, Frank T1 - Incidence of back pain in adolescent athletes BT - a prospective study N2 - Background Recently, the incidence rate of back pain (BP) in adolescents has been reported at 21%. However, the development of BP in adolescent athletes is unclear. Hence, the purpose of this study was to examine the incidence of BP in young elite athletes in relation to gender and type of sport practiced. Methods Subjective BP was assessed in 321 elite adolescent athletes (m/f 57%/43%; 13.2 ± 1.4 years; 163.4 ± 11.4 cm; 52.6 ± 12.6 kg; 5.0 ± 2.6 training yrs; 7.6 ± 5.3 training h/week). Initially, all athletes were free of pain. The main outcome criterion was the incidence of back pain [%] analyzed in terms of pain development from the first measurement day (M1) to the second measurement day (M2) after 2.0 ± 1.0 year. Participants were classified into athletes who developed back pain (BPD) and athletes who did not develop back pain (nBPD). BP (acute or within the last 7 days) was assessed with a 5-step face scale (face 1–2 = no pain; face 3–5 = pain). BPD included all athletes who reported faces 1 and 2 at M1 and faces 3 to 5 at M2. nBPD were all athletes who reported face 1 or 2 at both M1 and M2. Data was analyzed descriptively. Additionally, a Chi2 test was used to analyze gender- and sport-specific differences (p = 0.05). Results Thirty-two athletes were categorized as BPD (10%). The gender difference was 5% (m/f: 12%/7%) but did not show statistical significance (p = 0.15). The incidence of BP ranged between 6 and 15% for the different sport categories. Game sports (15%) showed the highest, and explosive strength sports (6%) the lowest incidence. Anthropometrics or training characteristics did not significantly influence BPD (p = 0.14 gender to p = 0.90 sports; r2 = 0.0825). Conclusions BP incidence was lower in adolescent athletes compared to young non-athletes and even to the general adult population. Consequently, it can be concluded that high-performance sports do not lead to an additional increase in back pain incidence during early adolescence. Nevertheless, back pain prevention programs should be implemented into daily training routines for sport categories identified as showing high incidence rates. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 310 KW - Injury KW - Pain occurrence KW - Training volume KW - Young athletes Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-101874 ER - TY - GEN A1 - Müller, Juliane A1 - Engel, Tilman A1 - Müller, Steffen A1 - Stoll, Josefine A1 - Baur, Heiner A1 - Mayer, Frank T1 - Effects of sudden walking perturbations on neuromuscular reflex activity and three-dimensional motion of the trunk in healthy controls and back pain symptomatic subjects N2 - Background Back pain patients (BPP) show delayed muscle onset, increased co-contractions, and variability as response to quasi-static sudden trunk loading in comparison to healthy controls (H). However, it is unclear whether these results can validly be transferred to suddenly applied walking perturbations, an automated but more functional and complex movement pattern. There is an evident need to develop research-based strategies for the rehabilitation of back pain. Therefore, the investigation of differences in trunk stability between H and BPP in functional movements is of primary interest in order to define suitable intervention regimes. The purpose of this study was to analyse neuromuscular reflex activity as well as three-dimensional trunk kinematics between H and BPP during walking perturbations. Methods Eighty H (31m/49f;29±9yrs;174±10cm;71±13kg) and 14 BPP (6m/8f;30±8yrs;171±10cm;67±14kg) walked (1m/s) on a split-belt treadmill while 15 right-sided perturbations (belt decelerating, 40m/s2, 50ms duration; 200ms after heel contact) were randomly applied. Trunk muscle activity was assessed using a 12-lead EMG set-up. Trunk kinematics were measured using a 3-segment-model consisting of 12 markers (upper thoracic (UTA), lower thoracic (LTA), lumbar area (LA)). EMG-RMS ([%],0-200ms after perturbation) was calculated and normalized to the RMS of unperturbed gait. Latency (TON;ms) and time to maximum activity (TMAX;ms) were analysed. Total motion amplitude (ROM;[°]) and mean angle (Amean;[°]) for extension-flexion, lateral flexion and rotation were calculated (whole stride cycle; 0-200ms after perturbation) for each of the three segments during unperturbed and perturbed gait. For ROM only, perturbed was normalized to unperturbed step [%] for the whole stride as well as the 200ms after perturbation. Data were analysed descriptively followed by a student´s t-test to account for group differences. Co-contraction was analyzed between ventral and dorsal muscles (V:R) as well as side right:side left ratio (Sright:Sleft). The coefficient of variation (CV;%) was calculated (EMG-RMS;ROM) to evaluate variability between the 15 perturbations for all groups. With respect to unequal distribution of participants to groups, an additional matched-group analysis was conducted. Fourteen healthy controls out of group H were sex-, age- and anthropometrically matched (group Hmatched) to the BPP. Results No group differences were observed for EMG-RMS or CV analysis (EMG/ROM) (p>0.025). Co-contraction analysis revealed no differences for V:R and Srigth:Sleft between the groups (p>0.025). BPP showed an increased TON and TMAX, being significant for Mm. rectus abdominus (p = 0.019) and erector spinae T9/L3 (p = 0.005/p = 0.015). ROM analysis over the unperturbed stride cycle revealed no differences between groups (p>0.025). Normalization of perturbed to unperturbed step lead to significant differences for the lumbar segment (LA) in lateral flexion with BPP showing higher normalized ROM compared to Hmatched (p = 0.02). BPP showed a significant higher flexed posture (UTA (p = 0.02); LTA (p = 0.004)) during normal walking (Amean). Trunk posture (Amean) during perturbation showed higher trunk extension values in LTA segments for H/Hmatched compared to BPP (p = 0.003). Matched group (BPP vs. Hmatched) analysis did not show any systematic changes of all results between groups. Conclusion BPP present impaired muscle response times and trunk posture, especially in the sagittal and transversal planes, compared to H. This could indicate reduced trunk stability and higher loading during gait perturbations. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 317 Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-394931 ER -