Validation of a Clinical Test of Thoracolumbar Dissociation in Chronic Low Back Pain

Abstract

Motor control deficits are common in chronic/recurrent low back pain (LBP) 3,13,19,24,33,34,36 and include altered paraspinal muscle function. 4,5,19,29 Recovery from LBP does not ensure restoration of spine function or movement, and recurrent LBP involves persistent alterations of motor control, including modified coordination between short/deep (eg, multifidus) and long/ superficial (eg, thoracic erector spinae) paraspinal muscles, with a tendency to contract these muscles en masse rather than to activate T T BACKGROUND:Control deficits of back muscles and trunk movement are common in chronic/recurrent low back pain (LBP). A reliable clinical test to rate an individual's ability to dissociate lumbopelvic movement from the thoracolumbar region has been described. This test rates the performance quality of 5 key aspects against criterion standards. T T METHODS: Concurrent validity was examinedby comparison of clinical test scores (overall score and each individual criterion) against spine kinematics. Discriminant validity was evaluated by comparison of scores between pain-free controls and participants with LBP. A receiver operating characteristic curve was calculated to determine the optimal cutoff or score to differentiate between good and poor performers. T T RESULTS:Concurrent validity was supported by the significant correlation between the total score and motion of the T5 vertebra relative to the S1 vertebra (P<.05). Scores for some (4 correlations of 14 measures) but not all individual criteria were correlated with the kinematic features that each criterion was expected to reflect. Discriminant validity was supported by higher test scores for pain-free controls than for participants with LBP after 2 minutes of training (P = .045). Scores of less than 5.5 were more prevalent in the LBP group (pretraining LBP versus control, 72% versus 35%; P = .008; posttraining LBP versus control, 48% versus 16%; P = .018). T T CONCLUSION:This preliminary study of concurrent and discriminant validity of the test provides a foundation to further investigate its utility to characterize thoracolumbar movement patterns in individuals with LBP.

Changes in the Organization of the Secondary Somatosensory Cortex While Processing Lumbar Proprioception and the Relationship With Sensorimotor Control in Low Back Pain

“…in the NSLBP population. 28,83 A similar observation has been made in primates with focal hand dystonia, who exhibited a loss of discrete organization of finger representations in somatosensory cortices, which coincided with a reduced ability to isolate finger movements. 84 However, this hypothesis remains elusive, as we only applied proprioceptive stimuli (i.e., muscle vibration) to one lumbar level (i.e., L4-5).…”

Impaired Core Stability as a Risk Factor for the Development of Lower Extremity Overuse Injuries: A Prospective Cohort Study

“…Validity and reliability for the tests used in this study were established in previous research. 13,[16][17][18][21][22][23]27,40 Three participants experienced physical discomfort during testing and were excluded. As such, 139 participants were considered for statistical analysis (mean 6 SD age, 19.5 6 1.4 years).…”

Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial

“…We used a single-session intervention, which consisted of 2 × 2 min of pelvic tilt exercises in the sagittal plane, with 30 s of rest in between. Pelvic tilt exercises are often used in the rehabilitation of patients with CLBP, and their purpose is to (re)gain movement control of the lumbar spine and pelvis [40,41]. The latter can be important, as it has been suggested that poor movement control may be an underlying mechanism contributing to the persistence of CLBP [42].…”