Movement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back pain

Abstract

Background Movement and posture are commonly believed to relate to non‐specific low back pain (NSLBP). While people with NSLBP appear to move and posture themselves differently from those without NSLBP, changes in movement and posture infrequently relate to improvements in NSLBP when analysed at a group‐level. Additionally, little is known about how movement or posture change when clinical outcome improves. Methods Within‐person relationships were investigated using a replicated, repeated measures, single‐case design in 12 people with persistent, disabling NSLBP. Individually relevant movement and posture were captured using wearable sensors on up to 20 occasions over a 22‐week period (5‐week baseline, 12‐week physiotherapy‐led intervention, 5‐week follow‐up), while pain and activity limitation were collected concomitantly. A series of cross‐correlation analyses estimated the presence, strength, and direction of relationships. Results Many participants (n = 10/12) had strong (e.g. r = 0.91, p = <0.001) relationships between changes in movement or posture and changes in pain and activity limitation, while some showed no strong association. Where relationships were observed, clinical improvement predominantly (93% or 57/61 relationships) related to increased spinal movement range and velocity during forward bending and lifting, reduced lumbar muscle EMG activity at maximum voluntary flexion, and increased posterior‐pelvic‐tilt during sitting and standing. Conclusion Within‐person changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. When changes were related, movement and posture appear to return towards being ‘less protective’, however causal directions remain unknown. Important activities, movements, and postural parameters varied across the participants, highlighting the potential importance of individualized management. Significance Changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. Patient‐specific activities, and movement or postural parameters that related to improved pain and activity limitation, varied across the 12 participants, highlighting the potential importance of individualised management. Where clinical improvements were related to changes in movement or posture, participants consistently returned towards being ‘less protective’ (increased range and speed of movement, increased posterior‐pelvic‐tilt during sitting and standing). Mechanisms and generalizability remain unclear.

Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP

“…For clinicians managing people with LBP related to lifting, advising them to adopt more squat-like lifting techniques in order to reduce the risk of LBP or manage it lacks evidence. Recent research supports that recovery from chronic and disabling LBP is associated with movement patterns that society perceives to be less safe (a more flexed lumbar spine and faster movement speed) [45]. The lack of clear associations with lifting biomechanics and pain intensity during repeated lifting in this study, suggests a range of factors across biopsychosocial domains should be explored to best assist those with lifting-related LBP [73,74].…”

“…Although this cross-sectional study cannot determine the cause-effect relationship of LBP related to lifting, or the reason for the differences seen in lifting technique, previous research has demonstrated that people both with LBP [42,43] and without LBP [44], who have higher levels of pain-related fear, lift with less lumbar flexion. There is also evidence that as people with chronic LBP improve, how they perform activities such as bending and lifting becomes faster with greater lumbar ROM in most cases [45]. Together this work suggests that people with LBP perceive squat-like lifting to be 'protective' during bending and lifting and therefore move accordingly.…”

Patients With Chronic Low Back Pain Have an Individual Movement Signature: A Comparison of Angular Amplitude, Angular Velocity and Muscle Activity Across Multiple Functional Tasks

“…Therefore, although this study showed a redundancy among the tasks, it is possible that some functional tasks may be more sensitive, for example with respect to pain intensity or pain-related fear. In this regard, some authors suggested that selecting a specific task for each individual based on their identified limitations could be helpful when analyzing the relationships between spinal movement and patient-related outcomes ( Wernli et al, 2020a ). It is currently unknown if selecting one sagittal-plane task based on the individual limitation would be more appropriate to analyze such relationships and future studies should address this gap.…”

Creencias y actitudes de los atletas sobre el dolor lumbar

“…Además, la relación causal entre las posturas de la columna vertebral y el dolor lumbar carece de consenso. [29][30][31][32] Es interesante resaltar que investigaciones previas han demostrado que aquellos que creen que levantar con la espalda recta es más seguro, puntuaron más alto en el Back-PAQ que aquellos que eligen una espalda redondeada. 15,17 Las creencias protectoras alrededor de la espalda fueron altamente prevalentes.…”