BACKGROUND: Patients with chronic lumbar back pain (CLBP) often present with an altered gait profile, which is a crucial element of good functioning in everyday life. In patients with multisegmental spinal pathologies and incongruity between radiologic imaging and clinical presentation, inpatient gradual diagnostics (IGD) is performed to determine the precise origin of the disabling pain. The underlying principle of IGD is the assumption that by locally administering an analgesic and anti-inflammatory agent to possible surgical target areas, the surgical effect can be temporarily simulated. The conclusions drawn from IGD are, however, mostly based on the patients' subjective feedback about pain relief.RESEARCH QUESTION: The aim of this study was to evaluate whether reported pain relief during IGD can be objectified by gait analysis. We hypothesized that patients with greater pain relief during IGD would show greater improvement in their pathologic gait and stance.METHODS: Treadmill gait and stance analyses were prospectively performed on CLBP patients before and after a one-week IGD. Self-report measures included the numeric pain rating scale (NRS) and the Oswestry Disability Index (ODI).RESULTS AND SIGNIFICANCE: Compared with a reference group (n = 28), IGD patients (n = 57) at admission showed reduced velocity, cadence, step length, and swing phase (p < .01 each). Their stance phase was increased by 5% of the gait cycle, and a more asymmetrical total load distribution during stance was observed. No difference was seen in stride width or foot rotation. While many patients reported good pain relief during IGD, no correlation was observed between subjective improvement and treadmill measures. We can thus confirm a pathologic gait profile in patients with CLBP. Based on our findings, gait analysis would not yet seem suitable to objectify IGD results. The short time interval between admission and discharge may not suffice to change a pathological gait that has developed over years.
Adult Aged