Trunk-pelvis motion, joint loads, and muscle forces during walking with a transtibial amputation

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.