Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis

Abstract

BackgroundClinicians commonly examine posture and movement in people with the belief that correcting dysfunctional movement may reduce pain. If dysfunctional movement is to be accurately identified, clinicians should know what constitutes normal movement and how this differs in people with low back pain (LBP). This systematic review examined studies that compared biomechanical aspects of lumbo-pelvic movement in people with and without LBP.MethodsMEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2014 for relevant studies. Studies had to compare adults with and without LBP using skin surface measurement techniques to measure lumbo-pelvic posture or movement. Two reviewers independently applied inclusion and exclusion criteria, and identified and extracted data. Standardised mean differences and 95% confidence intervals were estimated for group differences between people with and without LBP, and where possible, meta-analyses were performed. Within-group variability in all measurements was also compared.ResultsThe search identified 43 eligible studies. Compared to people without LBP, on average, people with LBP display: (i) no difference in lordosis angle (8 studies), (ii) reduced lumbar ROM (19 studies), (iii) no difference in lumbar relative to hip contribution to end-range flexion (4 studies), (iv) no difference in standing pelvic tilt angle (3 studies), (v) slower movement (8 studies), and (vi) reduced proprioception (17 studies). Movement variability appeared greater for people with LBP for flexion, lateral flexion and rotation ROM, and movement speed, but not for other movement characteristics. Considerable heterogeneity exists between studies, including a lack of detail or standardization between studies on the criteria used to define participants as people with LBP (cases) or without LBP (controls).ConclusionsOn average, people with LBP have reduced lumbar ROM and proprioception, and move more slowly compared to people without LBP. Whether these deficits exist prior to LBP onset is unknown.

Effect of Mulligan Concept Lumbar SNAG on Chronic Nonspecific Low Back Pain

“…[27][28][29][30][31] A systematic review conducted recently reported a reduction in proprioception along with decrease in ROM and slowed movement in patients with LBP compared with normal counterparts. 32 The results of this study support the link between LBP and proprioception deficits.…”

Concurrent validity and reliability of a novel wireless inertial measurement system to assess trunk movement

“…Movement dysfunctions in patients suffering from diseases such as low back pain (LBP), stroke and Parkinson's disease can be clinically assessed by measuring their trunk range of motion (ROM) and their reaction to specific movement control tasks (Laird et al, 2014;Verheyden et al, 2007;Cole et al, 2010). Specifically, these assessments are comprised of (1) ROM (Laird et al, 2014), (2) movement control impairment (MCI) (Sahrmann, 2002;Luomajoki et al, 2007), (3) repetitive movement (RM) tests (Dideriksen et al, 2014), and (4) tests for proprioception deficits such as reposition error tests (RE) (Rausch Osthoff et al, 2015).…”

Assessing the clinical utility of combined movement examination in symptomatic degenerative lumbar spondylosis

“…Furthermore, there seems to be a lack of normative data which can be used to inform outcomes from intervention to manage spinal pain. A systematic review and meta-analysis by Laird et al (2014), comparing lumbar kinematics in people with and without LBP, concluded that their results do not improve the understanding of the relationship between movement and pain in individuals. They also noted the difficulty in attempting a meaningful interpretation of the data due to the varied methodologies, samples and symptoms reported by the different studies.…”

“…Assessing lumbar spine movement in the clinical setting to investigate dysfunction and to monitor changes in spinal movement characteristics of individuals over time, is routine clinical practice (Ha et al, 2013;Laird et al, 2014;Lyle et al, 2005;Maitland, 1997). Single plane movements are often unrepresentative of the actual movements of the lumbar spine, so have limited value in assessing lumbar function (Pearcy and Hindle, 1989).…”