Modifying patterns of movement in people with low back pain -does it help? A systematic review

Background: Physiotherapy for people with low back pain frequently includes assessment and modification of lumbo-pelvic movement. Interventions commonly aim to restore normal movement and thereby reduce pain and improve activity limitation. The objective of this systematic review was to investigate: (i) the effect of movement-based interventions on movement patterns (muscle activation, lumbo-pelvic kinematics or postural patterns) of people with low back pain (LBP), and (ii) the relationship between changes in movement patterns and subsequent changes in pain and activity limitation. Methods. MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2012. Randomised controlled trials or controlled clinical trials of people with LBP were eligible for inclusion. The intervention must have been designed to influence (i) muscle activity patterns, (ii) lumbo-pelvic kinematic patterns or (iii) postural patterns, and included measurement of such deficits before and after treatment, to allow determination of the success of the intervention on the lumbo-pelvic movement. Twelve trials (25% of retrieved studies) met the inclusion criteria. Two reviewers independently identified, assessed and extracted data. The PEDro scale was used to assess method quality. Intervention effects were described using standardised differences between group means and 95% confidence intervals. Results: The included trials showed inconsistent, mostly small to moderate intervention effects on targeted movement patterns. There was considerable heterogeneity in trial design, intervention type and outcome measures. A relationship between changes to movement patterns and improvements in pain or activity limitation was observed in one of six studies on muscle activation patterns, one of four studies that examined the flexion relaxation response pattern and in two of three studies that assessed lumbo-pelvic kinematics or postural characteristics. Conclusions: Movement-based interventions were infrequently effec tive for changing observable movement patterns. A relationship between changes in movement patterns and improvement in pain or activity limitation was also infrequently observed. No independent studies confirm any observed relationships. Challenges for future research include defining best methods for measuring (i) movement aberrations, (ii) improvements in movements, and (iii) the relationship between changes in how people move and associated changes in other health indicators such as activity limitation

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

Background: Clinicians 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. Methods. MEDLINE, 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. Results: The 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). Conclusions: On 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

Kinematic and temporal interactions of the lumbar spine and hip during trunk extension in healthy male subjects

Kinematic properties of trunk extension are considered sensitive differentiators of movement between asymptomatic and low back pain subjects. The aim of this study was to quantify the continuous interaction of the hip and lumbar spine kinematics and temporal characteristics as a function of direction during the task of trunk bending backwards and returning to the upright position in healthy young subjects. The sagittal hip and lumbar spine kinematics during the extension task were examined in 18 healthy male subjects. Five trials of trunk extension were recorded for each subject and paired t-tests were then used to determine significant differences (P < 0.05) between the mean lumbar and the hip time-normalized kinematic and temporal variables. The data from the full cycle of trunk extension was analyzed with respect to movement initiation, time to reach peak velocity and peak angular displacement during the full cycle of trunk extension. Three distinct phases of movements were identified based on the continuous movement trajectories of velocity and angular displacement in the lumbar spine and hip; that of extension, return and, a terminal overcorrection phase. There were significant differences identified in the respective mean peak angular velocities of the lumbar spine (21.7 ± 8.6, 37.0 ± 14.7, 8.3 ± 5.0 deg/s) when compared with those of hip (14.6 ± 6.1, 21.7 ± 8.5, 5.4 ± 3.5 deg/s) in each of these three phases. The lumbar spine initiated the movement of trunk extension when bending backwards and returning to the upright position significantly early than that of the hip. These results highlight that in normal healthy adults there is the tendency for the lumbar spine to dominate over the hip during the task of backward trunk bending in terms of the amount and velocity of movement. At the end of extension the kinematics of the lumbar spine and hip kinematic are characterized by a terminal overcorrection phase marking the completion of the movement