Article

People with unilateral, transtibial amputation (TTA) have an increased prevalence
of chronic low back pain (LBP) relative to able-bodied people. However, a
definitive cause of increased LBP susceptibility has not been determined. The
purpose of this work was to compare dynamic trunk-pelvis biomechanics between
people with (n=6) and without (n=6) unilateral TTA during walking using a
computational modeling approach. A generic, muscle-actuated whole body model was
scaled to each participant, and experimental walking data were used in a static
optimization framework to calculate trunk-pelvis motion, L4L5 joint contact
forces, and muscle forces within the trunk-pelvis region. Results included
several significant between-group differences in trunk-pelvis biomechanics during
different phases of the gait cycle. Most significant was greater lateral bending
toward the residual side during residual single-limb stance (p<0.01), concurrent
with an elevated L4L5 joint contact force (p=0.02) and greater muscle force from
the intact-side obliques (p<0.01) in people with TTA relative to able-bodied
people. During both double-limb support phases, people with TTA also had a
greater range of axial trunk rotation away from the leading limb, concurrent with
greater ranges of muscle forces in the erector spinae and obliques. In addition,
a greater range of force (p=0.03) in residual-side psoas was found during early
residual limb swing in people with TTA. Repeated exposure to atypical motion and
joint/muscle loading in people with TTA may contribute to the development of
secondary musculoskeletal disorders, including chronic, mechanical LBP.
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Langue : ANGLAIS