Multiplanar lumbopelvic control in patients with low back pain: is multiplanar assessment better than single plane assessment in discriminating between patients and healthy controls?

Abstract

Objectives: Patients with low back pain (LBP) commonly have lumbopelvic control deficits. Lumbopelvic assessment during sagittal motion is incorporated into commonly used clinical examination algorithms for Treatment Based Classification. The purpose of this study was to investigate whether combined assessment of lumbopelvic control during sagittal and frontal plane motion discriminates between people with and without LBP better than single plane assessment alone. Methods: Nineteen patients with LBP and 18 healthy control participants volunteered for this study. The active straight leg raise (ASLR) and active hip abduction (AHAbd) tests were used to assess lumbopelvic control during sagittal and frontal plane motion, respectively. The tests were scored as positive or negative using published scoring criteria. Contingency tables were created for each test alone and for the combined tests (both positive/both negative) with presence/absence of LBP as the reference standard to calculate accuracy statistics of sensitivity (sn), specificity (sp), likelihood (zLR and 2LR), and diagnostic odds ratios (OR). Results: Active straight leg raise and AHAbd tests alone had sn of 0.63, 0.74, respectively, sp of 0.61, 0.50, respectively, and OR of 2.7, 2.8, respectively. The combined tests had sn50.89, sp50.60, and OR512.0. Forty percent of patients with LBP had control deficits in both planes of motion. Discussion: The AHAbd and ALSR tests appear to have greater diagnostic discrimination when used in combination than when used independently. A percentage of patients with LBP had control deficits in both planes, while others demonstrated uniplanar deficits only. These findings highlight the importance of multiplanar assessment in patients with LBP.Keywords: Low back pain, Lumbopelvic assessment, Active straight leg raise, Active hip abduction Level of Evidence: 2b (Diagnosis -exploratory cohort study with independent reference standard). ObjectivesLow back disorders are a significant health care issue in North America with an age-adjusted rate of 27.8% of all people over the age of 18 years reporting low back pain (LBP) each year, 1 and 80% of all individuals experiencing an episode of LBP during their lifetimes. 2 The economic and social impact of LBP is large, accounting for 1 in 25 health care resource visits resulting in an annual cost of $193.9 billion. 1 Despite the enormous resources that are dedicated to management of LBP, successful outcomes remain relatively low, having variable recurrence rates (5-60%) with an estimated 20% progressing into chronicity. 3The majority of individuals seeking treatment for LBP have no detectable structural cause with current imaging techniques and are therefore given the diagnosis of non-specific LBP (ns-LBP).4 Dysfunctional movement strategies, including kinematic and muscle activation differences, have been identified in people with ns-LBP when compared to healthy controls. [5][6][7][8] Asymptomatic people who reported a LBP response to a functional standing task also demonstrated diffe...

Trunk muscle activation patterns during active hip abduction test during remission from recurrent low back pain: an observational study

“…Therefore, subjects were required to practice to become familiar with the movements before data collection; no such practice exercises were performed by the subjects in the previous study. The differences in the AHAbd test method limit comparisons with previous studies [ 12 , 13 , 15 , 43 ], and because the practice before data collection provided subjects with the opportunity to learn the exercises, the scores of the test could not be evaluated in this study.…”

“…Therefore, some subjects in this study needed to abduct the hip to near the end of their range of motion. Due to these differences in method, the AHAbd test used in this study was more difficult to maintain in terms of the frontal plane alignment of the pelvis, due to larger internal perturbations than the methods used in the previous study [ 12 , 13 , 15 , 43 ]. Therefore, subjects were required to practice to become familiar with the movements before data collection; no such practice exercises were performed by the subjects in the previous study.…”

“…The method for conducting the AHAbd test used in this study differed in some aspects from previously reported methods. In previous AHAbd tests, the subject performed active hip abduction at a natural speed with up to 80 % of their available range of motion [ 12 , 13 , 15 , 43 ]. However, in this study, the subject performed active hip abduction of 30°, as fast as possible, because the speed of limb movement has been reported to affect the onset of trunk muscle activation.…”

Association of Piriformis Thickness, Hip Muscle Strength, and Low Back Pain Patients with and without Piriformis Syndrome in Malaysia

“…Evidence from the literature reflects the interconnection between the piriformis and hip muscles in providing stability and control of the lumbopelvic-hip complex [ 12 ]. Back muscle control and the stability of the lumbopelvic region are important to transfer forces between the spine and lower limbs [ 13 ] at the thoracolumbar fascia when performing multitask activities [ 14 ]. The three muscles: gluteus maximus, piriformis, and posterior fibre of the gluteus medius, are recognised as sustaining trunk and pelvic rotational activities while bearing weight over one limb [ 12 ].…”