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Low-Back Pain in Transfemoral Amputees: Is There a Correlation with Static or Dynamic Leg-Length Discrepancy?

Morgenroth, David C. MD; Shakir, Ali MD; Orendurff, Michael S. MS; Czerniecki, Joseph M. MD

American Journal of Physical Medicine & Rehabilitation: February 2009 - Volume 88 - Issue 2 - p 108-113
doi: 10.1097/PHM.0b013e318194fbbc
Original Research Article: Amputee
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Morgenroth DC, Shakir A, Orendurff MS, Czerniecki JM: Low-back pain in transfemoral amputees: Is there a correlation with static or dynamic leg-length discrepancy? Am J Phys Med Rehabil 2009;88:108–113.

Objective: Low-back pain (LBP) is an important cause of secondary disability in transfemoral amputees (TFA). The correction of leg-length discrepancy (LLD) is a common clinical approach to the treatment of LBP in this population. The aim of our study is to assess the relationship of static and dynamic LLD and LBP in a sample TFA population.

Design: Nine TFA with LBP and eight TFA without LBP were studied. Static leg length was measured with subjects standing in a self-selected comfortable position. Dynamic leg length was measured during the single-limb support and double-limb support phases of the gait cycle.

Results: There were no statistically significant differences between the pain and no pain groups in terms of static LLD (P = 1.0; 95% confidence interval, −6.8 to 6.6 mm); dynamic LLD during single-limb support (P = 0.3; 95% confidence interval, −27.3 to 7.3 mm); dynamic LLD during double-limb support with either the prosthetic limb leading (P = 0.3; 95% confidence interval, −4.0 to 12.2 mm) or the intact foot leading (P = 0.8, 95% confidence interval, −6.4 to 7.8 mm).

Conclusions: This study calls into question whether LLD plays a significant role in persistence of LBP in TFA. Further study of the effects of LLD and its possible relationship to causation of LBP in amputees is needed.

From the Rehabilitation Research and Development Center of Excellence in Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle, Washington (DCM, MSO, JMC); the Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (DCM, JMC); and Western Reserve Spine and Pain Institute, Kent, Ohio (AS).

All correspondence and requests for reprints should be addressed to David C. Morgenroth, MD, Rehabilitation Care Services (117-RCS), VAPSHCS, 1660 S. Columbian Way, Seattle, WA 98108.

This work was supported by VA research grants (A4843C and A2661C), which funded the VAPSHCS Center of Excellence for Limb Loss Prevention and Prosthetic Engineering; Department of Veterans Affairs, Rehabilitation Research and Development Service. The authors do not have any financial benefits. The research presented in this manuscript has not been previously presented in any form.

© 2009 Lippincott Williams & Wilkins, Inc.