Lumbar lordosis in prone position and prone hip extension test: comparison between subjects with and without low back pain

Abstract

BackgroundProne hip extension (PHE) is a common and widely accepted test used for assessment of the lumbo-pelvic movement pattern. Considerable increased in lumbar lordosis during this test has been considered as impairment of movement patterns in lumbo-pelvic region. The purpose of this study was to investigate the change of lumbar lordosis in PHE test in subjects with and without low back pain (LBP).MethodA two-way mixed design with repeated measurements was used to investigate the lumbar lordosis changes during PHE in two groups of subjects with and without LBP. An equal number of subjects (N = 30) were allocated to each group. A standard flexible ruler was used to measure the size of lumbar lordosis in prone-relaxed position and PHE test in each group.ResultThe result of two-way mixed-design analysis of variance revealed significant health status by position interaction effect for lumbar lordosis (P < 0.001). The main effect of test position on lumbar lordosis was statistically significant (P < 0.001). The lumbar lordosis was significantly greater in the PHE compared to prone-relaxed position in both subjects with and without LBP. The amount of difference in positions was statistically significant between two groups (P < 0.001) and greater change in lumbar lordosis was found in the healthy group compared to the subjects with LBP.ConclusionsGreater change in lumbar lordosis during this test may be due to more stiffness in lumbopelvic muscles in the individuals with LBP.

Lumbar Multifidus and Erector Spinae Muscle Synergies in Patients with Nonspecific Low Back Pain During Prone Hip Extension: A Cross‐sectional Study

“…One possible explanation is that patients use an altered trunk muscle activation strategy to stiffen their lumbopelvic region to minimize shear forces or pain. This explanation was supported by several studies in which they found less lumbopelvic motion during functional tasks . Because conflicting evidence still exists, investigation of lumbopelvic movement and trunk muscle activation strategy is needed to clarify this issue.…”

“…The main objective of this study was to determine the differences in lumbopelvic motion and muscle activation pattern between patients with nonspecific LBP and healthy individuals during PHE. Based on current evidence, we expected that patients with nonspecific LBP would demonstrate a difference in the amount of lumbopelvic motion. In addition, we further hypothesized that patients would demonstrate altered trunk muscle activation patterns.…”

“…3,4 Lumbar stabilization exercise is one of the most common exercise interventions for patients with nonspecific LBP. 5 Although research demonstrates altered movement patterns in this population and improvement in clinical outcomes (eg, pain intensity and disability index) after lumbar stabilization exercise, [5][6][7][8] the underlying biomechanical change contributing to these findings has not been comprehensively investigated.…”

“…3,4 Although theory and clinical observation suggest that patients with nonspecific LBP, compared to asymptomatic individuals, would have greater lumbopelvic movement during PHE, research evidence demonstrates conflicting findings. 6,9 Some studies report that healthy individuals demonstrated greater lumbar lordosis during PHE compared with patients with nonspecific LBP. One possible explanation is that patients use an altered trunk muscle activation strategy to stiffen their lumbopelvic region to minimize shear forces or pain.…”

Changes in L4/5 Intervertebral Foramen Bony Morphology with Age

“…The lifetime prevalence of LBP is reported to be as high as 84% 3 . Radiculopathy is a common cause of low back and leg pain 4 .…”