Understanding spinal loading in persons with traumatic lower limb amputations

Recent conflicts in Afghanistan and Iraq have led to nearly 300 lower limb amputations in the British military alone. A number of complications are associated with limb loss including low back pain (LBP) which is commonly reported as a secondary disability of amputation. Despite much published literature into LBP amongst those with lower limb amputations, few have focused on the traumatic aetiology, especially from within the military, who tend to be younger and fitter than those with amputations due to vascular or diabetic reasons, and thus have a higher level of functioning. Whilst the association between amputation and LBP is agreed, it is the causality that is less clear. The focus of this thesis is to gain a deeper understanding of the mechanics behind LBP in persons with traumatic amputations by studying the kinematics and kinetics of the lumbar spine and lower limbs amongst these persons during activities of daily living. Insights into possible mechanisms has the potential to inform care, management and the longer term rehabilitation process to improve quality of life in those with lower limb loss. Following suggestions in published literature that fatigue is a significant factor in the propagation of LBP in this cohort, this study focused on analysing the gait performance before, during and after a six minute walk test (6MWT). Motion analysis was used to understand the spatiotemporal characteristics, kinematics and kinetics of veterans who had experienced traumatic lower limb loss. The results indicated the importance of including all classifications of lower limb amputations in research studies involving those with amputations. There were differences in the 6MWT, spatiotemporal, kinematic and kinetic results between the different groups. It was observed that inducing muscle fatigue in the cohorts highlighted some of the compensation mechanisms, which otherwise may have gone unnoticed. Although individuals may display similar ankle, knee or hip mechanisms, the variations in the lower lumbar and upper lumbar joints are very different and may be unique to individual participant. This emphasises the need for subject specific mathematical models that are able to factor in the individual amputation characteristics. The work in this thesis gives a solid foundation for understanding compensatory mechanisms in those with amputations, which can lead to individual rehabilitation or re-education programmes to ultimately prevent long-term musculoskeletal problems and improve quality of life in persons with traumatic lower limb amputations.Open Acces