- Title
- The gluteus medius muscle, foot type, and foot orthoses: an investigation of contribution to, and treatment of, chronic nonspecific low back pain
- Creator
- Sadler, Sean George
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Globally, low back pain (LBP) is a major public health problem. It is the leading cause of disability worldwide, and is the number one reason for activity limitation and absenteeism from work internationally. LBP has a significant negative impact on the physical and psychological wellbeing of sufferers, with assessment and management of the condition costing hundreds of billions of dollars annually. Further, most of the financial, physical, and emotional burden of LBP is related to those who suffer chronic nonspecific LBP. Musculoskeletal structures and function have been implicated in the development and exacerbation of chronic nonspecific LBP, however, there are limited systematic evaluations of existing studies in these areas. Furthermore, international guidelines advocate for the use of non-invasive treatments for the management of chronic nonspecific LBP. Foot orthoses are a commonly available, conservative intervention with some research demonstrating that they may be a successful intervention for the management of chronic nonspecific LBP, although further investigation is required. This thesis provides a comprehensive evaluation of existing research investigating the role of musculoskeletal structures for the development and exacerbation of LBP, as well as the identification of possible therapeutic targets for management, and an evaluation of a non-invasive treatment for chronic nonspecific LBP. This thesis begins with a systematic review which aimed to investigate the role of lower limb and lower back musculoskeletal structures in the development of LBP (chapter 2). This systematic review is the first to show through meta-analysis that reduced lateral flexion range of motion, limited lumbar lordosis, and restricted hamstring range of motion are likely to be risk factors for the development of LBP in adults (chapter 2). This was followed by a second systematic review investigating the differences in gluteus medius muscle function in those with and without LBP (chapter 3). It was found that participants with LBP consistently demonstrated reduced strength and more trigger points compared to the gluteus medius muscle of those without LBP (chapter 3). The review also found that there is inconclusive evidence regarding gluteus medius muscle activity in those with and without LBP, which formed the basis for the studies in the following two chapters. Firstly, we conducted an intratester reliability study investigating surface electromyography measurement of gluteus medius muscle activity during gait in people with and without mild to moderate chronic nonspecific LBP. We found that this technique has good levels of intratester reliability (chapter 4). This was followed by a case-control study in which we demonstrated that gluteus medius muscle activity during gait is not likely to be significantly different in those with and without mild to moderate chronic nonspecific LBP (chapter 5). Although no difference between groups was found, the study did demonstrate that those with mild to moderate chronic nonspecific LBP and pronated feet are more likely to demonstrate higher peak gluteus medius muscle activity during gait. Additionally, the study also found for those without LBP, the opposite relationship between foot type and gluteus medius muscle activity occurred. Specifically in those without LBP, a weak correlation was found between higher arched feet and higher peak gluteus medius muscle activity during gait, suggesting further research in larger groups of high arched feet is required. Therefore, we recruited more people without LBP and measured their foot type and gluteus medius muscle activity during gait (chapter 6). Subsequently, we found that in adults without LBP, those with a cavus foot type are more likely to have higher levels of mean and peak amplitude and greater range of gluteus medius muscle activity during gait compared to participants with neutral and planus foot types. Following this, and in all people without LBP, we investigated the effect of prefabricated foot orthoses on gluteus medius muscle activity. It was demonstrated that, regardless of the amount of usage, the prefabricated foot orthoses were not able to significantly influence gluteus medius muscle activity over four weeks in healthy adults. The final study in this thesis aimed to investigate the short term effect of prefabricated foot orthoses on pain and function in people with chronic nonspecific LBP in a pilot randomised controlled trial (chapter 7). Secondarily, the trial aimed to report on the safety and adherence of the interventions as a means of supporting ongoing recruitment and longer term follow-up of participants in the trial. We were able to recruit a total of 41 participants over a 10 month period, with 20 participants randomised to the intervention group (prefabricated foot orthotic and The Back Book, which is an educational booklet on managing LBP) and 21 to the control group (The Back Book only). Although there was no significant difference in pain and function between the groups after 12 weeks, both interventions were found to be safe and have high adherence, supporting ongoing recruitment and follow-up as part of a prospectively registered, adequately powered randomised controlled trial and published study protocol. The investigations undertaken for this thesis have established likely musculoskeletal risk factors for the development of LBP, and contributed to a better understating of how the gluteus medius muscle functions in those with and without LBP. Furthermore, we have demonstrated that electromyography is a reliable assessment technique for measuring gluteus medius muscle activity in those with and without mild to moderate chronic nonspecific LBP, and provided evidence for how both cavus and planus foot types affects gluteus medius muscle activity during gait in these populations. We have also provided evidence to support ongoing evaluation of prefabricated foot orthoses for the treatment of chronic nonspecific LBP.
- Subject
- gluteus medius; low back pain; biomechanics; foot orthoses; electromyography; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1513074
- Identifier
- uon:56693
- Rights
- Copyright 2021 Sean George Sadler
- Language
- eng
- Full Text
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