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Center for Advancement of Osteopathic Research Methodologies

Investigating Objective Functional Characteristics to Differentiate Subgroups in Chronic Low Back Pain Patients.        

SRI Scientists

  • Brian Degenhardt, DO
  • Jeremy Houser, PhD
  • Jane Johnson, MA
  • Tamara McCleod, PhD, ATC, CSCS
  • Ken Pamperin, MS
  • Eric Snider, DO
  • Karen Snider, DO
  • Steve Webb, BA, BS

Other Investigators

  • Micheal Bird, PhD

Purpose and Aims

Low back pain is a major medical, economic, and psychosocial issue.  The causes and subsequent treatments are not clearly understood.  In order to advance the understanding of the underlying physiology of this complaint, it is believed that low back pain patients should be properly sub-grouped using common traits or behaviors.  A reliable measure of population differentiation may help guide the treatment of low back pain related problems, particularly in relation to osteopathic treatments.

Thus, the long-term objective of this line of research is to determine if objective measurements of muscle activity and balance can consistently differentiate between the following groups: those with a history and clinical signs of chronic low back pain of spinal origin (LBP), those subjects with unilateral chronic posterior pelvic pain of likely sacroiliac joint origin (SIJP), and those with no low back or pelvic pain (Control).  If so, comparative effectiveness studies may be performed to evaluate various interventions such as osteopathic manipulative treatments, exercise, and pharmaceuticals.  Osteopathic palpatory diagnostic tests are also being objectively quantified and recorded to determine the predictive qualities of these tests to differentiate between these groups.

A feasibility study was completed using 10 subjects per group.  A manuscript is near completion for that study.  In the follow-up, more definitive study, the specific aims of this project are to investigate any unique differences in muscle recruitment and movement characteristics across the 3 populations during 3 functional movements: step-up-and-over, squat, and bend-over-and-up.  A total of 160 female participants (age 18-50; BMI ≤ 30), 40 within each group group (including a group with widespread pain), will be age- and BMI-matched.  Pain subjects will be required to have had at least 1 episode of moderate to high levels (4+ on 0-10 scale) of LBP or SIJP for no less than 3 months at a frequency ≥5 days per week.  After providing informed consent, participants will complete a set of questionnaires (medical history, Oswestry Low Back Pain Disability Scale, and PROMIS-29 Profile), followed by a series of tasks to train them for the motor activities that will be performed.  A standardized physical examination will be conducted.  Lastly, participants will be instrumented with surface electromyography (sEMG) and will complete a set of activities on the NeuroCom® Balance Master System to assess differences in muscle activation patterns and functional abilities across the 3 groups. Surface EMG will measure multifidus, iliocostalis, longissimus, transversus abdominis, gluteus maximus, gluteus medius, and long head of biceps femoris muscles bilaterally.  Normalized magnitudes of muscle activation, patterns of muscle activation, and functional performance outcomes will be compared bilaterally and between groups.

This study is the first interdisciplinary, intercampus and multi-institutional research project within ATSU.  Both osteopathic medical schools, the schools for physical therapy and athletic training are participating in this study.

 

Dissemination

Publications
  1. Snider KT, Johnson JC, Degenhardt BF, Snider EJ, Burton DC. Association of low back pain, somatic dysfunction, and lumbar bone mineral density: reproducibility of findings. J Am Osteopath Assoc. 2014;114(5):356-367.
  2. Snider KT, Johnson JC, Degenhardt BF, Snider EJ. Low back pain, somatic dysfunction, and segmental bone mineral density T-score variation in the lumbar spine. J Am Osteopath Assoc. 2011 Feb;111(2):89-96. 
Presentations and Abstracts
  1. Houser JJ, Degenhardt BF, Hodges C, Kirsch J, Pazdernik V, Yang Q, Webb SJ, Shurtz NR, McDonald M [alum], Molzen E, Webb EK, Pamperin K. Relationship of pelvic landmark positional asymmetry tests to low back pain syndromes. J Am Osteopath Assoc. 2014;114(8):e94.
  2. Snider KT, Johnson JC, Degenhardt BFSnider EJ. The Persistence of Lumbar Somatic Dysfunction and its Association with Bone Mineral Density. Poster presented at: AOA Research Conference; Las Vegas, NV; September 30, 2013. Abstract. J Am Osteopath Assoc. 2013;113(8):e8-e9.