Walking with chronic non-specific low back pain--a failed strategy: what can we learn from sports?

The present theoretical consideration is focused on the different behaviours of patients with chronic non-specific low back pain and healthy people when walking. The ground reaction force pattern and its direct influence on the success of the applied strategy are of special interest. This consideration does not clarify whether or not and to what limit the indicated pattern is the main cause or compensatory effect of chronic non-specific low back pain. It is known that pain patients exhibit divergent walking patterns. In addition to a shorter stride, the relationship between swing-to-stance phase shifts in the direction of stance. This strategy should contribute to an improvement in the control. Simultaneously, the impact and the forces should be reduced. Recent studies refer to different activation behaviours of the bi-articular Musculus biceps femoris. According to our analysis, this muscle owns a key function concerning force transmission. The type of force transmission immediately influences system loading. The strategy exhibited by patients with chronic non-specific back pain fails due to false activations, in particular false activations of the M. biceps femoris. The essential objective of the strategy for reducing the maxima of the applied forces, as well as to distribute the force over a longer period of time, was implemented; however, it could be shown that the increase in the maximum force is clearly reached early. Such a fast development in force is equivalent to higher loadings to the human system. This concerns visco-elastic structures in particular. Due to the fast increasing forces, these structures possess low or insufficient damping properties. If our hypothesis of the failed strategy holds true, it might be the basis for new therapeutic approaches, as well as diagnostics involving non-specific low back pain.