Introduction to clinical issues
The delicate historical moment we’re living in has profoundly changed our lifestyle and habits with important repercussions on health. Coronavirus’ emergency has in fact forced millions of people to work from home, favoring a prolonged period of physical inactivity. This way of working can lead to numerous postural problems such as low back pain (more commonly called “back pain”).
This issue, in industrialized countries, affects between 60% and 80% of adults at least once in their life [1]. Interesting statistics emerge from data collected by the World Health Organization and surveys published in the International Journal of Environmental Research and Publich Health. While 72% of workers who were already suffering from low back pain saw their pain exacerbate, the percentage of new cases increased by 11% compared to the pre-quarantine period.
Importance of assessment in clinical problems
Low back pain is an extremely complex condition and there are many physical risk factors that can cause it, like:
• Previous problems
• Reduced joint mobility
• Extensive pain
• Low level of physical activity
• Overweight
• Other motor disorders
The best course of treatment can be established by evaluating these essential aspects:
• A thorough analysis of joint mobility at the lumbar level and in adjacent body districts.
• Monitoring of musculoskeletal disorders during deambulation, so that the clinician can better investigate and understand the patient’s real difficulties in performing activities of daily living, including walking [2]
Another aspect that should not be overlooked during assessment is the ability to maintain balance. Low back pain can, indeed, have a negative impact on this matter, like increasing the risk of falling [3],[4],[5]. Objective information obtained in this way allows to have an exhaustive portrait of the subject’s motor status and to plan a physiotherapy suitable to his actual state. As suggested by related guidelines, this rehabilitation program should aim to minimize physical inactivity and promote therapeutic exercises [6]; it is considered, moreover, as one of the most effective therapies from the earliest stages of the disease, as it can manage pain, acting on its modulatory mechanisms [7].
Importance of objective technological assessment
Quantifying joint movements with visual inspection is extremely difficult; therefore, the use of reliable instruments is necessary [8]. The support of technology becomes even more important in the analysis of complex movements - such as walking – because it allows measurements of quantities otherwise undetectable. These include speed, stride length, symmetry, stance phase, flight phase and pelvis movements.
In this context, inertial technology is the first choice for reliability and ease of use. In the evaluation phase, it permits the collection of objective data through tests such as:
• Trunk articularity
• Walking test
• Gait
• Timed Up&Go
The same instrumentation allows, then, to design a rehabilitation program based on therapeutic exercises guided by biofeedback that help the patient to acquire awareness about his movement, ensuring excellent results. Among these exercises, it is crucial to consider the training of proprioception of the trunk [9] and to take care of the strengthening of the stabilizing muscles [10], which are fundamental in the return to normal condition.
Conclusion
In an extremely widespread pathology - with disabling consequences – such as low back pain, having access to wearable technology is crucial to deepen the assessment of the problem and propose targeted therapeutic exercises. Working with these new devices, therefore, means not only a higher quality of assessment, but also a more rapid and lasting outcome of the rehabilitation process.
Bibliography
[1] Parsons, S., Ingram, M., Clarke-Cornwell, A., & Symmons, D. (2011). A Heavy Burden: the occurrence and impact of musculoskeletal conditions in the United Kingdom today.
[2] Koch, C., & Hänsel, F. (2018). Chronic non-specific low back pain and motor control during gait. Frontiers in psychology, 9, 2236.
[3] Mientjes, M. I. V., & Frank, J. S. (1999). Balance in chronic low back pain patients compared to healthy people under various conditions in upright standing. Clinical Biomechanics, 14(10), 710-716.
[4] da Silva, R. A., Vieira, E. R., Fernandes, K. B., Andraus, R. A., Oliveira, M. R., Sturion, L. A., & Calderon, M. G. (2018). People with chronic low back pain have poorer balance than controls in challenging tasks. Disability and Rehabilitation, 40(11), 1294-1300.
[5] Springer, B. A., Marin, R., Cyhan, T., Roberts, H., & Gill, N. W. (2007). Normative values for the unipedal stance test with eyes open and closed. Journal of geriatric physical therapy, 30(1), 8-15.
[6] Airaksinen, O., Brox, J. I., Cedraschi, C., Hildebrandt, J., Klaber-Moffett, J., Kovacs, F., ... & COST B13 Working Group on Guidelines for Chronic Low Back Pain. (2006). European guidelines for the management of chronic nonspecific low back pain. European spine journal, 15(Suppl 2), s192.
[7] Vaegter, H. B., & Jones, M. D. (2020). Exercise-induced hypoalgesia after acute and regular exercise: experimental and clinical manifestations and possible mechanisms in individuals with and without pain. Pain Reports, 5(5).
[8] Mayer, T. G., Kondraske, G., Beals, S. B., & Gatchel, R. J. (1997). Spinal range of motion: accuracy and sources of error with inclinometric measurement. Spine, 22(17), 1976-1984
[9] Gong, W. (2014). The influence of lumbar joint mobilization on joint position sense in normal adults. Journal of physical therapy science, 26(12), 1985-1987.
[10] Kim, C. R., Park, D. K., Lee, S. T., & Ryu, J. S. (2016). Electromyographic changes in trunk muscles during graded lumbar stabilization exercises. PM&R, 8(10), 979-989.