Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Introduction: Lumbar spinal stenosis (LSS) is a common cause of low back pain (LBP) and impacts approximately 200,000 adults in the United States¹. Neurogenic claudication (NC) associated with LSS often causes symptomatic pain, discomfort, and weakness². As a result, LSS may impair ambulation and cause functional disability.³ Although functional movement limitations have been previously identified, there is a paucity of literature on the impact of this pathology on physical activities (e.g. weightlifting) and joint range of motion (RoM). The aim of this study was to evaluate lifting technique and disability in patients with NC and compare it to healthy controls.

Methods: Participants were fitted with a full-body external reflective marker set. Each participant completed six lifting tasks where a box weighing less than 10% of their total body weight was lifted onto a one-meter-high table: three trials were completed with the box to the right and three with the box to the left. Linear mixed-effects regression models were used to estimate the intercept at the subject level.

Results: Forty-four patients with NC and thirty-four healthy controls were included in this study. When analyzing the beginning posture of the symmetrical lifting task, patients with NC presented with reduced bilateral hip (left: 87.6°, right: 86.3° vs 97.9°, p = 0.001) and knee (left: 59.7°, right: 64.1° vs 93.7°, p = 0.001) flexion angles relative to healthy controls. Moreover, these patients presented with increased anterior pelvis tilt (40.0°, vs 23.5°, p = 0.001), and lumbar spine flexion (69.1°, vs 49.7°, p = 0.001) when compared to controls at the begging of the lift. Regarding range of motion (RoM), patients with NC completing the asymmetrical lift presented with reduced bilateral hip (left: 58.5°, right: 57.2° vs 74.9°, p = 0.001) and knee (left: 55.5°, right: 57.8° vs 92.2°, p = 0.001) flexion relative to controls. Additionally, patients with NC completing this activity also presented with greater lumbar spine flexion RoM (64.1°, vs 59.0°, p = 0.044) relative to controls.

Discussion: This study’s results indicate that patients with LSS show significant disability when performing symmetric lifting movements compared to matched controls. In addition, our study illustrates the mechanical load placed on the lumbar spine during symmetric lifting tasks, resulting in an increase in anterior pelvis tilt and lumbar spine flexion, putting the spine at an increased mechanical risk and leading to advanced neurogenic symptoms.  To our knowledge, no prior studies have demonstrated the functional deficits of LSS with motion-capture. This information can be used by clinicians in the design of neuromuscular control training programs to improve control and stability of lower extremities and the spine for individuals with LSS. Furthermore, the results of this study will prove valuable for spine care providers who are designing neuromuscular control training programs for patients with low back pain who wish to regain full functional abilities. Appreciation of the biomechanical forces applied to the lumbar spine during symmetric lifting movements can further be used to tailor improved lumbar surgical approaches and rehabilitation treatment plans.