The effect of attentional focus on local dynamic stability during a repetitive spine flexion task

The association between low back pain and spine movement control suggests that it is important to reliably quantify movement behavior. One method to characterize spine movement behavior is to measure the local dynamic stability (LDS) of spine movement during a repetitive flexion task in which a participant is asked to touch multiple targets repetitively. Within the literature, it has been well established that an individual’s focus of attention (FOA) can modulate their neuromuscular control and affect task performance. The goal of this project was to examine the unknown effect of FOA on LDS measurements and timing error during a repetitive spine flexion task that is commonly used to assess movement control. Fourteen healthy adults (7 male) were instructed to touch two targets (shoulder height and knee height) to the beat of a metronome (4 s/cycle) for 35 consecutive cycles. They completed this task under internal (focus on trunk movement) and external (focus on targets) FOA conditions. Motion capture data of the trunk and sacrum were collected at 120 Hz. The lumbar spine angle was defined as the orientation of the trunk relative to the pelvis. The local divergence exponent (λ_max) was calculated from the sum of squares of the 3-dimensional spine angle. Timing error was calculated as the time difference between target touches and metronome beats. Changing an individual’s FOA had no effect on λ_max calculations or timing error. Although clear task instructions are important, it is not essential to control for FOA during this movement assessment protocol.     

Comparing the local dynamic stability of trunk movements between varsity athletes with and without non-specific low back pain

The local dynamic stability of trunk movements, quantified using the maximum Lyapunov exponent (λ_max), can provide important information on the neuromuscular control of spine stability during movement tasks. Although previous research has displayed the promise of this technique, all studies were completed with healthy participants. Therefore the goal of this study was to compare the dynamic stability of spine kinematics and trunk muscle activations, as well as antagonistic muscle co-contraction, between athletes with and without low back pain (LBP). Twenty interuniversity varsity athletes (10 LBP, 10 healthy controls) were recruited to participate in the study. Each participant completed a repetitive trunk flexion task at 15 cycles per minute, both symmetrically and asymmetrically, while trunk kinematics and muscular activity (EMG) were monitored. The local dynamic stability of low back EMG was significantly higher (lower λ_max) in healthy individuals (p=0.002), whereas the dynamic stability of kinematics, the dynamic stability of full trunk system EMG, and the amount of antagonistic co-contraction were significantly higher when moving asymmetrically (p<0.05 for all variables). Although non-significant, kinematic and trunk system EMG stability also tended to be impaired in LBP participants, whereas they also tended to co-contract their antagonist muscles more. This study provides evidence that Lyapunov analyses of kinematic and muscle activation data can provide insight into the neuromuscular control of spine stability in back pain participants. Future research will repeat these protocols in patients with higher levels of pain, with hopes of developing a tool to assess impairment and treatment effectiveness in clinical and workplace settings.     

Pain catastrophizing moderates changes in spinal control in response to noxiously induced low back pain

It is generally accepted that spine control and stability are relevant for the prevention and rehabilitation of low back pain (LBP). However, there are conflicting results in the literature in regards to how these variables are modified in the presence of LBP. The aims of the present work were twofold: (1) to use noxious stimulation to induce LBP in healthy individuals to assess the direct effects of pain on control (quantified by the time-dependent behavior of kinematic variance), and (2) to assess whether the relationship between pain and control is moderated by psychological features (i.e. pain catastrophizing (PC) and kinesiophobia). Participants completed three conditions (baseline, pain, recovery) during a task involving completion of 35 cycles of a repetitive unloaded spine flexion/extension movement. The neuromuscular control of spine movements was assessed during each condition using maximum finite-time Lyapunov exponents (λ_max). Nociceptive stimulus involved injection of hypertonic saline into the interspinous ligament, eliciting pain that was greater than baseline and recovery (p < 0.001). Although there was no overall main effect of the nociceptive stimulation (i.e. pain) on λ_max when the whole group was included in the statistical model (p = 0.564), when data were considered separately for those with high and low PC, two distinct and well established responses to the pain were observed. Specifically, those with high PC tightened their control (i.e. stabilized), whereas those with low PC loosened their control (i.e. destabilized). This study provides evidence that individuals’ beliefs and attitudes towards pain are related to individual-specific motor behaviors, and suggests that future research studying spine control/stability and LBP should account for these variables.     

Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain

Observation-based assessments of movement are a standard component in clinical assessment of patients with non-specific low back pain. While aberrant motion patterns can be detected visually, clinicians are unable to assess underlying neuromuscular strategies during these tests. The purpose of this study was to compare coordination of the trunk and hip muscles during 2 commonly used assessments for lumbopelvic control in people with low back pain (LBP) and matched control subjects. Electromyography was recorded from hip and trunk muscles of 34 participants (17 with LBP) during performance of the Active Hip Abduction (AHAbd) and Active Straight Leg Raise (ASLR) tests. Relative muscle timing was calculated using cross-correlation. Participants with LBP demonstrated a variable strategy, while control subjects used a consistent proximal to distal activation strategy during both frontal and sagittal plane movements. Findings from this study provide insight into underlying neuromuscular control during commonly used assessment tests for patients with LBP that may help to guide targeted intervention approaches.     

Differences between two subgroups of low back pain patients in lumbopelvic rotation and symmetry in the erector spinae and hamstring muscles during trunk flexion when standing

The present study was performed to examine lumbopelvic rotation and to identify asymmetry of the erector spinae and hamstring muscles in people with and without low back pain (LBP). The control group included 16 healthy subjects, the lumbar-flexion–rotation syndrome LBP group included 17 subjects, and the lumbar-extension–rotation syndrome LBP group included 14 subjects. Kinematic parameters were recorded using a 3D motion-capture system, and electromyography parameters were measured using a Noraxon TeleMyo 2400T. The two LBP subgroups showed significantly more lumbopelvic rotation during trunk flexion in standing than did the control group. The muscle activity and flexion–relaxation ratio asymmetries of the erector spinae muscles in the lumbar-flexion–rotation syndrome LBP group were significantly greater than those in the control group, and the muscle activity and flexion–relaxation ratio asymmetry of the hamstring muscles in the lumbar-extension–rotation syndrome LBP group were significantly greater than those in the control group. Imbalance or asymmetry of passive tissue could lead to asymmetry of muscular activation. Muscle imbalance can cause asymmetrical alignment or movements such as unexpected rotation. The results showed a greater increase in lumbopelvic rotation during trunk flexion in standing among the lumbar-flexion–rotation syndrome and lumbar-extension–rotation syndrome LBP groups compared with the control group. The differences between the two LBP subgroups may be a result of imbalance and asymmetry in erector spinae and hamstring muscle properties.     

Force–velocity,force–power relationships of bilateral and unilateral leg multi-joint movements in young and elderly women

The present study investigated force–velocity and force–power relationships of bilateral and unilateral knee-hip extension movement in young and elderly women. Twelve healthy young (age, 19–31 yr) and 12 healthy elderly (age, 60–82 yr) women performed bilateral and unilateral knee-hip extension movements on the dynamometer against loads controlled by the servo system. Under the isotonic force condition, force–velocity relationships were measured. The maximum isometric force (F_max), unloaded velocity (V_max) and power output (P_max) of the movements were calculated from extrapolating force–velocity and force–power relationships. F_max and P_max of bilateral and unilateral knee-hip extension movements were 20–30% lower in elderly than in young women. On the other hand, there were no significant differences in V_max between young and elderly women and between bilateral and unilateral movements. Bilateral deficit was larger as the generation of force was larger in both young and elderly women. Also, bilateral deficit of F_max and P_max were not different between young and elderly women. The results were that lower maximum power output of bilateral and unilateral leg multi-joint movements in elderly women did not depend on the intrinsic shortening velocity of muscle action, but largely on reduction in force generating capacity. This suggests the importance of preventing a loss of force generating capacity of muscles during leg multi-joint movements in elderly women.     

Photosynthetic and morphological responses of eelgrass (Zostera marina L.) to a gradient of light conditions

Zostera marina L. (eelgrass) from Great Bay Estuary, New Hampshire and Maine (USA), was transplanted in outdoor mesocosms and subjected to four light treatments (100, 58, 34 and 11% surface irradiance, SI) between May and September 2003 to investigate the relationship between light availability and the growth and survival of eelgrass. Evaluating eelgrass seedlings and adult mature plants demonstrated no differences in photosynthetic response after 22 days of acclimation. During at least the first 19 days of shading, maximum electron transport rate (ETR_max) rate of eelgrass did not differ significantly between light treatments. After 40 days, a significant reduction in ETR_max and minimum saturating light was observed in plants growing at 34% SI and below. Morphological responses exhibited a linear increasing trend with greater light. 34% SI exhibited drastic reductions (to less than 25% of control) in rhizome growth, shoot density, shoot production, number of nodes per plant and plant weight at the end of the study (81 days). Shoot to root ratio at 34% SI increased by > 50%. Plants shaded to 58% SI showed no significant difference from the control in plant parameters except an increased rate of rhizome elongation. Our results link the lower shoot densities with shading to the slow growth rate of horizontal rhizomes and a total lack of lateral expansion at 11% SI. ETR_max declined over time in plants at 11% SI resulting in 81% mortality, no lateral branching and no morphological development, indicating that the minimum light required for long-term eelgrass growth and survival is greater than the previously suggested 11% SI. We demonstrate that eelgrass plants at these latitudes can persist at light levels of 58% SI and above, and are light-limited at 34% SI and below.     

Preempting Performance Challenges: The Effects of Inoculation Messaging on Attacks to Task Self-Efficacy

Although inoculation messages have been shown to be effective for inducing resistance to counter-attitudinal attacks, researchers have devoted relatively little attention toward studying the way in which inoculation theory principles might support challenges to psychological phenomena other than attitudes (e.g., self-efficacy). Prior to completing a physical (i.e., balance) task, undergraduates (N = 127, M_age = 19.20, SD = 2.16) were randomly assigned to receive either a control or inoculation message, and reported their confidence in their ability regarding the upcoming task. During the task, a confederate provided standardized negative feedback to all participants regarding their performance, and following the completion of the task, participants again reported their self-efficacy along with measures assessing in-task processes. Findings supported the viability of efficacy inoculation; controlling for pre-task self-efficacy, task performance, and relevant psycho-social variables (e.g., resilience, self-confidence robustness), participants in the inoculation condition reported greater confidence in their ability (i.e., task self-efficacy) than those in the control condition at post-task. Relative to those in the inoculation condition, participants in the control condition also experienced greater concentration disruption and self-presentation concerns during the task.     

The use of intermittent trunk flexion to alleviate low back pain during prolonged standing

The current study examined of the effect of intermittent, short-term periods of full trunk flexion on the development of low back pain (LBP) during two hours of standing. Sixteen participants completed two 2-h standing protocols, separated by one week. On one day, participants stood statically for 2 h (control day); on the other day participants bent forward to full spine flexion (termed flexion trials) to elicit the flexion relaxation (FR) phenomenon for 5 s every 15 min (experimental day). The order of the control and experimental day was randomized. During both protocols, participants reported LBP using a 100 mm visual analogue scale every 15 min. During the flexion trials, lumbar spine posture, erector spinae and gluteus medius muscle activation was monitored. Ultimately, intermittent trunk flexion reduced LBP by 36% (10 mm) at the end of a 2-h period of standing. Further, erector spinae and gluteus medius muscle quietening during FR was observed in 91% and 65% of the flexion trials respectively, indicating that periods of rest did occurred possibly contributing to the reduction in LBP observed. Since flexion periods do not require any aids, they can be performed in most workplaces thereby increasing applicability.     

An investigation of the flexion relaxation ratio in adults with and without a history of self-reported low back pain and transient sitting-induced pain

It is unknown whether the presence of sitting-induced pain or a clinical history of low back pain (LBP) changes spine function outcomes such as the flexion relaxation ratio (FRR). The purpose of this investigation was to determine whether sitting-induced pain or a history of non-specific LBP results in a different FRR. Forty-seven participants were instrumented with surface electromyography over erector spinae at L1, and accelerometers at L1 and S2. Standing maximum lumbar flexion trials were taken preceding and following a 1-hour sitting trial. Pain ratings during sitting and history of LBP were used to group participants for analysis. FRR values taken after the sitting exposures were compared between those that did and did not develop pain during sitting. Baseline FRR values were compared participants with and without a history of LBP. No significant differences in FRR were found for either pain groups (p = 0.11) or clinical history (p = 0.85). Lack of differences may be due to participants not currently experiencing a clinical episode of pain when the ratio was measured and/or because 1-hour sitting exposure was not long enough to induce pain modulation. The findings suggest that neither sitting-induced pain development or clinical history need to be controlled to prevent confounding of FRR.     

Effects of reversible cold block of face primary somatosensory cortex on orofacial movements and related face primary motor cortex neuronal activity

Our previous studies have revealed that face primary somatosensory cortex (SI) as well as face primary motor cortex (MI) play important roles in the control of orofacial movements in awake monkeys, and that both face MI and face SI neurons may have an orofacial mechanoreceptive field and show activity related to orofacial movements. Since it is possible that the movement-related activity of face MI neurons could reflect movement-generated orofacial afferent inputs projecting to face MI via face SI, the present study used reversible cold block-induced inactivation of the monkey's face SI to determine if face MI neuronal activity related to a trained tongue-protrusion task, chewing or swallowing was dependent on the functional integrity of the ipsilateral face SI and if inactivation of face SI affects orofacial movements. The effects of face SI cold block were tested on chewing, swallowing and/or task-related activity of 73 face MI neurons. Both task and chewing and/or swallowing-related activity of most face MI neurons was independent of the functional integrity of the ipsilateral face SI since SI cold block affected the movement-related activity in approximately 25% of the neurons. Similarly, unilateral cold block of SI had very limited effects on the performance of the task and chewing, and no effect on the performance of swallowing. These findings suggest that movement-induced reafferentation via face SI may not be a significant factor in accounting for the activity of the majority of ipsilateral face MI neurons related to trained movements, chewing and swallowing.     

Study on the synthesis and structure–effect relationship of multi‐aryl imidazoles with their fluorescence properties

In this paper, 23 multi‐aryl imidazole derivatives were synthesized and identified by nuclear magnetic resonance, ultraviolet‐visible and elemental analysis. At the same time, their ultraviolet‐visible maximum absorption (λ_ab^max), fluorescence emission maximum (λ_em^max) and quantum yields (Ф_f) were measured. The relationships between the optical behaviors and structures for these compounds were assessed. The results show that the λ^max_ab and λ^max_em are red‐shifted and the fluorescence Ф_f are increased by the introduction of electron‐withdrawing substituents and the increase in the planarity of multi‐aryl imidazole molecules. The results also showed that the fluorescence quantum yields of the compounds containing two imidazole nuclei are double the corresponding mono‐imidazole nucleus compounds. Copyright © 2013 John Wiley & Sons, Ltd.     

Estimated absorbance spectra of the visual pigments of the North Atlantic right whale (Eubalaena glacialis)

To assess the spectral sensitivities of the retinal visual pigments from the North Atlantic right whale (Eubalaena glacialis), we have cloned and sequenced two exons from the rod opsin gene and two exons from the middle‐wavelength sensitive (MWS) cone opsin gene in order to determine the amino acids at positions known to be key regulators of the spectral location of the absorbance maximum (λ_max). Based on previous mutagenesis models we estimate that the right whale possesses a rod visual pigment with a λ_max of 499 nm and a MWS cone visual pigment with a λ_max of 524 nm. Although the MWS cone visual pigment from the right whale is blue‐shifted in its spectral sensitivity like those from odontocetes, the spectral sensitivity of the right whale rod visual pigment is similar to those from terrestrial mammals.     

Effects of reflex delays on postural control during unstable seated balance

Patients with low-back pain (LBP) exhibit longer trunk muscle reflex latencies and poorer postural control than healthy individuals. We hypothesized that balance during a simulated postural control task would become impaired when the delays exhibited by LBP patients were incorporated into neuromuscular control. The task chosen for this investigation was seated balancing, which emphasizes trunk muscles’ contribution in postural control. This task was modeled in Simulink? as a fourth order linearized dynamic system with feedback delays. Optimization (minimizing error between experimental and model data) of state variables was used to determine neuromuscular control parameters. Experimental data were obtained from 7 subjects during 5 perturbation trials while balancing on the seat with eyes closed. Model accuracy, reflecting the ability of the model to capture the dynamics of seated balance, was correlated with seated balance performance (r=0.91, p<0.001). To minimize the risk of erroneous findings from inaccurate modeling, only the best five balancers’ data were used for hypothesis testing. In these five subjects, feedback delays in modeled neuromuscular control were increased to determine their effect on task stability, trunk displacement and trunk moment. Simulations showed that longer delays found in LBP, in general, did not produce unstable balancing, but did result in increased trunk displacement (p<0.001) and trunk moment (p=0.001). This impairment in neuromuscular control in chronic LBP patients could possibly exacerbate their condition by increasing tissue strain (more spinal displacement) and stress (more spinal loading).     

Properties and functions of KATP during mouse perinatal development

BackgroundPrevailing data suggest that ATP-sensitive potassium channels (K_ATP) contribute to a surprising resistance to hypoxia in mammalian embryos, thus we aimed to characterize the developmental changes of K_ATP channels in murine fetal ventricular cardiomyocytes.MethodsPatch clamp was applied to investigate the functions of K_ATP. RT-PCR, Western blot were used to further characterize the molecular properties of K_ATP channels.ResultsSimilar K_ATP current density was detected in ventricular cardiomyocytes of late development stage (LDS) and early development stage (EDS). Molecular–biological study revealed the upregulation of Kir6.1/SUR2A in membrane and Kir6.2 remained constant during development. Kir6.1, Kir6.2, and SUR1 were detectable in the mitochondria without marked difference between EDS and LDS. Acute hypoxia–ischemia led to cessation of APs in 62.5% of tested EDS cells and no APs cessation was observed in LDS cells. SarcK_ATP blocker glibenclamide rescued 47% of EDS cells but converted 42.8% of LDS cells to APs cessations under hypoxia-ischemic condition. MitoK_ATP blocker 5-HD did not significantly influence the response to acute hypoxia–ischemia at either EDS or LDS. In summary, sarcK_ATP played distinct functional roles under acute hypoxia-ischemic condition in EDS and LDS fetal ventricular cardiomyocytes, with developmental changes in sarcK_ATP subunits. MitoK_ATP were not significantly involved in the response of fetal cardiomyocytes to acute hypoxia–ischemia and no developmental changes of K_ATP subunits were found in mitochondria.     

The use of Girard-T reagent in a rapid and sensitive methods for measuring glyoxal and certain other alpha-dicarbonyl compounds.

Girard-T reagent (trimethylaminoacetohydrazide chloride) under mild acid or alkaline conditions, reacts with aldehydes and ketones containing α-dicarbonyl functional groups to produce addition compounds which strongly absorb ultraviolet light. The glyoxal adduct has a λ_max of 295 nm and an E_max of 2.73 × 10⁴ at pH < 6; it has a λ_max of 325 nm and an E_max of 1.88 × 10⁴ at pH > 9. As little as 5 nmol of glyoxal can be measured accurately; absorbance is linear with concentrations up to at least 3500 nmol, and the reaction is complete within 10 min. A variation of the method is described which permits the detection of certain α-dicarbonyl compounds on paper. Another variation allows the measurement of glyoxal in a glyoxal-guanylic acid adduct, a previously described modified nucleotide.     

Motor Imagery in Asperger Syndrome: Testing Action Simulation by the Hand Laterality Task

Asperger syndrome (AS) is a neurodevelopmental condition within the Autism Spectrum Disorders (ASD) characterized by specific difficulties in social interaction, communication and behavioural control. In recent years, it has been suggested that ASD is related to a dysfunction of action simulation processes, but studies employing imitation or action observation tasks provided mixed results. Here, we addressed action simulation processes in adolescents with AS by means of a motor imagery task, the classical hand laterality task (to decide whether a rotated hand image is left or right); mental rotation of letters was also evaluated. As a specific marker of action simulation in hand rotation, we assessed the so-called biomechanical effect, that is the advantage for judging hand pictures showing physically comfortable versus physically awkward positions. We found the biomechanical effect in typically-developing participants but not in participants with AS. Overall performance on both hand laterality and letter rotation tasks, instead, did not differ in the two groups. These findings demonstrated a specific alteration of motor imagery skills in AS. We suggest that impaired mental simulation and imitation of goal-less movements in ASD could be related to shared cognitive mechanisms.     

Effects of reversible cold block of face primary somatosensory cortex on orofacial movements and related face primary motor cortex neuronal activity

Our previous studies have revealed that face primary somatosensory cortex (SI) as well as face primary motor cortex (MI) play important roles in the control of orofacial movements in awake monkeys, and that both face MI and face SI neurons may have an orofacial mechanoreceptive field and show activity related to orofacial movements. Since it is possible that the movement-related activity of face MI neurons could reflect movement-generated orofacial afferent inputs projecting to face MI via face SI, the present study used reversible cold block-induced inactivation of the monkey's face SI to determine if face MI neuronal activity related to a trained tongue-protrusion task, chewing or swallowing was dependent on the functional integrity of the ipsilateral face SI and if inactivation of face SI affects orofacial movements. The effects of face SI cold block were tested on chewing, swallowing and/or task-related activity of 73 face MI neurons. Both task and chewing and/or swallowing-related activity of most face MI neurons was independent of the functional integrity of the ipsilateral face SI since SI cold block affected the movement-related activity in approximately 25% of the neurons. Similarly, unilateral cold block of SI had very limited effects on the performance of the task and chewing, and no effect on the performance of swallowing. These findings suggest that movement-induced reafferentation via face SI may not be a significant factor in accounting for the activity of the majority of ipsilateral face MI neurons related to trained movements, chewing and swallowing.     

Kinematic chain reactions on trunk and dynamic postural steadiness in subjects with recurrent low back pain

Although subjects with recurrent low back pain (LBP) demonstrate altered trunk control, the kinematic and kinetic responses of the trunk have not been carefully investigated. This study was conducted to compare the standing time, spine range of motion (ROM), and dynamic postural steadiness index (DPSI) based on visual condition between subjects with and without recurrent LBP during upright one leg standing. Sixty-three individuals participated in the study, including 34 control subjects and 29 subjects with recurrent LBP. The DPSI was a composite of the medio-lateral (MLSI), anterior-posterior (APSI), and vertical steadiness indices (VSI) on a force platform. The control group demonstrated longer standing time (s) during the eyes-open condition than the LBP group (26.82 ± 6.03 vs. 19.87 ± 9.36; t = 2.96, p = 0.01). Regarding spine ROM, visual condition was significantly different between groups (F = 7.09, p = 0.01) and demonstrated interactions with spine region and group (F = 5.53, p = 0.02). For the kinetic measures, there was a significant interaction between visual conditions and indices (F = 25.30, p = 0.001). In the LBP group, the DPSI was significantly correlated with the MLSI (r = 0.59, p = 0.002), APSI (r = 0.44, p = 0.03), and VSI (r = 0.98, p = 0.01) in the eyes-closed condition. Overall, the results of this study indicated that the LBP group decreased thorax and lumbar spine rotations during the eyes-closed condition. The LBP group also demonstrated positive correlations with the kinetic indices, enhancing dynamic postural steadiness in the eyes-closed condition in order to possibly avoid pain or further injury. This dynamic postural steadiness strategy is necessary to improve kinetic and kinematic chain reactions in the LBP group. This compensatory pattern supports the development of optimal postural correction strategies to prevent LBP recurrence and might represent a chain reaction to protect trunk control without visual input.     

Altered flexion-relaxation responses exist during asymmetric trunk flexion movements among persons with unilateral lower-limb amputation

Repetitive exposures to altered gait and movement following lower-limb amputation (LLA) have been suggested to contribute to observed alterations in passive tissue properties and neuromuscular control in/surrounding the lumbar spine. These alterations, in turn, may affect the synergy between passive and active tissues during trunk movements. Eight males with unilateral LLA and eight non-amputation controls completed quasi-static trunk flexion–extension movements in seven distinct conditions of rotation in the transverse plane: 0° (sagittally-symmetric), ±15°, ±30°, and ±45° (sagittally-asymmetric). Electromyographic (EMG) activity of the bilateral lumbar erector spinae and lumbar kinematics were simultaneously recorded. Peak lumbar flexion and EMG-off angles were determined, along with the difference (“DIFF”) between these two angles and the magnitude of peak normalized EMG activities. Persons with unilateral LLA exhibited altered and asymmetric synergies between active and passive trunk tissues during both sagittally-symmetric and -asymmetric trunk flexion movements. Specifically, decreased and asymmetric passive contributions to trunk movements were compensated with increases in the magnitude and duration of active trunk muscle responses. Such alterations in trunk passive and active neuromuscular responses may result from repetitive exposures to abnormal gait and movement subsequent to LLA, and may increase the risk for LBP in this population.