Effect of Real-Time Kinematic Visual Biofeedback on Neuromuscular Re-education and Lumbo-Pelvic Control in Adults with Lumbar Hyperlordosis

Abstract

ABSTRACT

Introduction: Lumbar hyperlordosis is associated with a biomechanical imbalance characterized by pelvic anteversion, weakness of the deep stabilizing musculature (core), and alteration of the somatosensory map. Traditionally, physical therapy interventions have relied on verbal and manual commands in static unloading or flexibility positions. However, the integration of new technologies allows for the optimization of motor learning. Real-time visual biofeedback through digital kinematic analysis offers a disruptive tool that facilitates cortical reorganization and accelerates the acquisition of functional movement patterns by providing the patient with an objective and immediate reference of their lumbopelvic alignment during dynamic exercise execution.

Objective: To evaluate the efficacy of a neuromuscular re-education program assisted by real-time kinematic visual biofeedback on pelvic alignment, functional core strength, and proprioception in adults with lumbar hyperlordosis, compared to a conventional physical therapy protocol.

Methodology: A single-blind, randomized controlled clinical trial was conducted. Forty patients (aged 18 to 40) with a clinical and radiographic diagnosis of lumbar hyperlordosis (Ferguson's angle \bm{> 45^\circ}) were recruited. They were randomly divided into two groups of 20 participants. The Control Group (CG) received a conventional protocol consisting of motor control, lumbosacral flexibility, and lumbopelvic stabilization sequences guided by traditional mirrors and verbal commands. The Experimental Group (EG) performed the same movement and load-dosage program, incorporating a kinematic analysis system based on digital optical sensors and high-speed cameras connected to visual biofeedback software, which projected a real-time graphical interface of pelvic deviations during dynamic exercises (quadruped-to-standing transitions and spinal twist sequences). Both groups trained 3 sessions per week for 8 weeks. The variables evaluated pre- and post-intervention were: dynamic pelvic anteversion angle via digital photogrammetry, deep muscle endurance (McGill's test), and lumbopelvic joint repositioning error (propioception) measured in degrees.

Results: After 8 weeks, both groups showed significant improvements compared to baseline values. However, the Experimental Group (EG) demonstrated a statistically superior reduction in the dynamic pelvic anteversion angle compared to the CG (\bm{p < 0.01}). Likewise, the lumbopelvic joint repositioning error decreased significantly more in the EG (\bm{1.2^\circ \pm 0.4^\circ}) than in the CG (\bm{2.8^\circ \pm 0.6^\circ}, \bm{p < 0.05}), showing accelerated proprioceptive gains. McGill's test reported a significantly greater increase in core stabilizer endurance in the EG (\bm{p < 0.05}).

Conclusions: The inclusion of real-time kinematic visual biofeedback technologies in physical therapy programs significantly optimizes neuromuscular re-education in patients with lumbar hyperlordosis. This technological tool proved superior to conventional approaches in improving proprioceptive accuracy and dynamic pelvic control, establishing itself as a viable, efficient, and reproducible innovation for comprehensive rehabilitation and functional restoration of the spine.