Effects of Walking With a Shopping Trolley on Spinal Posture and Loading in Subjects With Neurogenic Claudication

Comer CM, White D, Conaghan PG, Bird HA, Redmond AC. Effects of walking with a shopping trolley on spinal posture and loading in subjects with neurogenic claudication. Arch Phys Med Rehabil 2010;91:1602-7. Objectives: To explore possible mechanisms underpinning symptom relief and improved walking tolerance in patients with neurogenic claudication (NC) when pushing a shopping trolley by evaluating the effects of a shopping trolley on spinal posture and loading patterns. Design: An exploratory study of kinematic and kinetic changes in walking with and without pushing a shopping trolley in persons with NC symptoms and a comparison with asymptomatic control subjects. Setting: A primary care based musculoskeletal service. Participants: Participants (n=8) with NC symptoms who have anecdotally reported symptomatic improvement when walking with a shopping trolley and a control group of asymptomatic persons (n=8). Interventions: Shopping trolley. Main Outcome Measures: Changes in lumbar spinal sagittal posture and ground reaction force. Results: Subjects with NC and asymptomatic controls walked with significantly more flexed spinal posture (increase in flexion, 3.40 degrees; z=3.516; P<.001) and reduced mean ground reaction forces (-6.9% of body weight; z= 3.46; P=.001) when walking with a shopping trolley. However, at the midstance point of the gait cycle, controls showed minimal reliance on the trolley, whereas, people with NC showed continued offloading. Conclusions: Both posture and loading are affected by pushing a shopping trolley; however, patients with NC were found to offload the spine throughout the stance phase of gait, whereas asymptomatic controls did not.