Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Back Pain | Research article

Does movement matter in people with back pain? Investigating ‘atypical’ lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors

Authors: Robert A. Laird, Jennifer L. Keating, Kasper Ussing, Paoline Li, Peter Kent

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Login to get access

Abstract

Background

Interventions for low back pain (LBP) commonly target ‘dysfunctional’ or atypical lumbo-pelvic kinematics in the belief that correcting aberrant movement improves patients’ pain and activity outcomes. If atypical kinematic parameters and postures have a relationship to LBP, they could be expected to more prevalent in people with LBP compared to people without LBP (NoLBP). This exploratory study measured, defined and compared atypical kinematic parameters in people with and without LBP.

Methods

Wireless inertial motion and EMG sensors were used to measure lumbo-pelvic kinematics during standing trunk flexion (range of motion (ROM), timing, sequence coordination, and extensor muscle activation) and in sitting (relative sitting position, pelvic tilt range) in a sample of 126 of adults without LBP and 140 chronic LBP subjects. Atypical movement was defined using the 10th/90th centiles of the NoLBP group. Mean differences and prevalence rates for atypical movement were calculated. Dichotomised pain scores for ‘high-pain-on-bending’ and ‘high-pain-on-sitting’ were tested for their association with atypical kinematic variables.

Results

For standing flexion, significant mean differences, after adjusting for age and gender factors, were seen for the LBP group with (i) reduced ROM (trunk flexion (NoLBP 111o, LBP 93o, p < .0001), lumbar flexion (NoLBP 52o, LBP 46o, p < .0001), pelvic flexion (NoLBP 59o, LBP 48o, p < .0001), (ii) greater extensor muscle activation for the LBP group (NoLBP 0.012, LBP 0.25 p < .0001), (iii) a greater delay in pelvic motion at the onset of flexion (NoLBP − 0.21 s; LBP − 0.36 s, p = 0.023), (iv) and longer movement duration for the LBP group (NoLBP 2.28 s; LBP 3.18 s, p < .0001). Atypical movement was significantly more prevalent in the LBP group for small trunk (× 5.4), lumbar (× 3.0) and pelvic ROM (× 3.9), low FRR (× 4.9), delayed pelvic motion at 20o flexion (× 2.9), and longer movement duration (× 4.7). No differences between groups were seen for any sitting parameters. High pain intensity was significantly associated with small lumbar ROM and pelvic ROM.

Conclusion

Significant movement differences during flexion were seen in people with LBP, with a higher prevalence of small ROM, slower movement, delayed pelvic movement and greater lumbar extensor muscle activation but without differences for any sitting parameter.
Appendix
Available only for authorised users
Literature
1.
Fersum KV, O'Sullivan P, Skouen JS, Smith A, Kvale A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2012;17(6):916–28.CrossRef
2.
Kent P, Laird R, Haines T. The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC Musculoskelet Disord. 2015;16:131–50.PubMedPubMedCentralCrossRef
3.
Laird R, Gilbert J, Kent P, Keating J. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15(1):229.PubMedPubMedCentralCrossRef
4.
Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Manual Ther. 2008;13(1):43–9.CrossRef
5.
Hodges P, Richardson C. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominus. Spine. 1996;21(22):2640–50.PubMedCrossRef
6.
Nelson-Wong E, Callaghan J. Transient Low Back pain development during standing predicts future clinical Low Back pain in previously asymptomatic individuals. Spine. 2014;39(6):E379–83.PubMedCrossRef
7.
Neblett R, Mayer TG, Gatchel RJ, Keeley J, Proctor T, Anagnostis C, Neblett R, Mayer TG, Gatchel RJ, Keeley J, et al. Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications. Spine. 2003;28(13):1435–46.PubMed
8.
Nelson-Wong E, Brendon A, Csepe D, Lancaster D, Callaghan JP. Altered muscle recruitment during extension from trunk flexion in low back pain developers. Clin Biomech. 2012;27:994–8.CrossRef
9.
Grimstone SK, Hodges PW. Impaired postural compensation for respiration in people with recurrent low back pain. Exp Brain Res. 2003;151(2):218–24.PubMedCrossRef
10.
Grenier SG, McGill SM. When exposed to challenged ventilation, those with a history of LBP increase spine stability relatively more than healthy individuals. Clin Biomech. 2008;23(9):1105–11.CrossRef
11.
Kell RT, Bhambhani Y, Kell RT, Bhambhani Y. In vivo erector spinae muscle blood volume and oxygenation measures during repetitive incremental lifting and lowering in chronic low back pain participants. Spine. 2006;31(22):2630–7.PubMedCrossRef
12.
Lamberg EM, Hagins M. The effects of low back pain on natural breath control during a lowering task. Eur J Appl Physiol. 2012;112(10):3519–24.PubMedCrossRef
13.
Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysliwiec LW. Comparison of trunk proprioception between patients with Low Back pain and healthy controls. Arch Phys Med Rehabil. 2010;91(9):1327–31.PubMedPubMedCentralCrossRef
14.
O'Sullivan PB, Burnett A, Floyd AN, Gadsdon K, Logiudice J, Miller D, Quirke H. Lumbar repositioning deficit in a specific low back pain population. Spine. 2003;28(10):1074–9.PubMedCrossRef
15.
Newcomer KL, Laskowski ER, Yu B, Johnson JC, An KN. Differences in repositioning error among patients with low back pain compared with control subjects. Spine. 2000;25(19):2488–93.PubMedCrossRef
16.
Moseley GL, Hodges PW. Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble? Behav Neurosci. 2006;120(2):474–6.PubMedCrossRef
17.
Villumsen M, Madeleine P, Jorgensen M, Holtermann A, Samani A. The variability of the trunk forward bending in standing activities during work vs. leisure time. Applied Ergonomics. 2016;58:273–80.PubMedCrossRef
18.
Hodges P, van den Horn W, Dawson A, Cholewicki J. Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. J Biomech. 2009;42(1):61–6.PubMedCrossRef
19.
Hodges PW, Coppieters MW, MacDonald D, Cholewicki J. New insight into motor adaptation to pain revealed by a combination of modelling and empirical approaches. Eur J Pain. 2013;17(8):1138–46.PubMedCrossRef
20.
Abboud J, Nougarou F, Page I, Cantin V, Massicote D, Descarreaux M. Trunk motor variability in patients with non-specific chronic low back pain. Eur J Appl Physiol. 2014.
21.
Pranata A, Perraton L, El-Ansary D, Clark R, Fortin K, Dettmen T, Bryant A. Lumbar extensor muscle force control is associated with disability in people with chronic low back pain. Clin Biomech. 2017;46:46–51.CrossRef
22.
Steele J, Bruce-Low S, Smith D. A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning. Curr Med Res Opin. 2014;30(5):865–911.PubMedCrossRef
23.
Kim M-h, Yi C-h, O-y K, Cho S-h, H-s C, Kim Y-h, Hwang S-h, B-r C, J-a H, Jung D-h. Comparison of Lumbopelvic rhythm and flexion-relaxation response between 2 different Low Back pain subtypes. Spine. 2013;38(15):1260–7.PubMedCrossRef
24.
O'Sullivan K, O'Sullivan P, O'Sullivan L, Dankaerts W. What do physiotherapists consider to be the best sitting spinal posture? Manual Ther. 2012;17(5):432–7.CrossRef
25.
Laird R, Kent P, Keating J. How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain? BMC Musculoskelet Disord. 2016;17:403–17.PubMedPubMedCentralCrossRef
26.
Laird R, Keating J, Kent P. There are subgroups of lumbo-pelvic flexion kinematics in people with and without back pain. BMC Musculoskelet Disord. 2018;19:309–22.PubMedPubMedCentralCrossRef
27.
Ross R, LaStayo P. Clinical Assessment of Pain. In: van Deusen J, Brunt D, editors. Assessment in Occupational Therapy and Physical Therapy. Philadelphia: WB Saunders Co; 1997.
28.
Roland M, Fairbank J. The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000;25(24):3115–24.PubMedCrossRef
29.
Kent PP, Lauridsen HHP. Managing missing scores on the Roland Morris disability questionnaire. Spine. 2011;36(22):1878–84.PubMedCrossRef
30.
Ronchi A, Lech M, Taylor N, Cosic I. A reliability study of the new Back strain monitor based on clinical trials. Conf Proc IEEE Eng Med Biol Soc. 2008;693-6:693–6.
31.
Floyd W, Silver P. The function of the erectores spinae muscles in flexion of the trunk. Lancet. 1951;6647:123–33.
32.
Geisser ME, Ranavaya M, Haig AJ, Roth RS, Zucker R, Ambroz C, Caruso M. A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. Journal of Pain. 2005;6(11):711–26.PubMedCrossRef
33.
Neblett R, Mayer TG, Brede E, Gatchel RJ. The effect of prior lumbar surgeries on the flexion relaxation phenomenon and its responsiveness to rehabilitative treatment. Spine J. 2014;14:892–902.PubMedCrossRef
34.
O'Connell GD, Vresilovic EJ, Elliott DM. Human intervertebral disc internal strain in compression: the effect of disc region, loading position, and degeneration. J Orthop Res. 2011;29(4):547–55.PubMedCrossRef
35.
Ahern DK, Follick MJ, Council JR, Laser-Wolston N, Litchman H. Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls. Pain. 1988;34(2):153–60.PubMedCrossRef
36.
Watson P, Booker C, Main C, Chen A. Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio. Clin Biomech. 1997;12:165–71.CrossRef
37.
Marshall P, Murphy B. Changes in the flexion relaxation response following an exercise intervention. Spine. 2006;31(23):E877–83.PubMedCrossRef
38.
Wong TK, Lee RY, Wong TKT, Lee RYW. Effects of low back pain on the relationship between the movements of the lumbar spine and hip. Hum Mov Sci. 2004;23(1):21–34.PubMedCrossRef
39.
Seay JF, E.A, Hamill J: Low back pain status affects pelvis-trunk coordination and variability during walking and running. Clin Biomech 2011, 26(6):572–578.
40.
Mjøsund HL, Boyle E, Kjaer P, Mieritx RM, Skallgard T, Kent P. Clinically acceptable agreement between the ViMove wireless motion sensor system and the Vicon motion capture system when measuring lumbar region inclination motion in the sagittal and coronal planes. BMC Musculoskelet Disord. 2017;18(124).
41.
Intolo P, Milosavljevic S, Baxter DG, Carman AB, Pal P, Munn J, Intolo P, Milosavljevic S, Baxter DG, Carman AB, et al. The effect of age on lumbar range of motion: a systematic review. Manual Ther. 2009;14(6):596–604.CrossRef
42.
Marras WS, Parnianpour M, Ferguson SA. al e: Quantification and classification low back disorders based on trunk motion. Eur J Phys Med. 1993;3:218–35.
43.
Marras WS, Wongsam PE. Flexibility and velocity of the normal and impaired lumbar spine. Arch Phys Med Rehabil. 1986;67(4):213–7.PubMed
44.
Geisser ME, Haig AJ, Wallbom AS, Wiggert EA, Geisser ME, Haig AJ, Wallbom AS, Wiggert EA. Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain. 2004;20(2):61–9.PubMedCrossRef
45.
Nitschke J, Nattrass C, Disler P, Chou M, Ooi K. Reliability of the American Medical Association Guides' model for measuring spinal range of motion: its implication for whole-person impairment rating. Spine. 1999;24(3):262–8.PubMedCrossRef
46.
Zuberbier O, Kozlowski A, Hunt D, Berkowitz J, Schultz I, Crook J, Milner R. Analysis of the convergent and discriminant validity of published lumbar flexion, extension, and lateral flexion scores. Spine. 2001;26(20):E472–8.PubMedCrossRef
47.
Poitras S, Loisel P, Prince F, Lemaire J. Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Arch Phys Med Rehabil. 2000;81(10):1394–400.PubMedCrossRef
48.
Mayer T, Kondraske G, Beals S, Gatchel R. Spinal range of motion. Accuracy and sources of error with inclinometric measurement. Spine. 1997;22:1976–84.PubMedCrossRef
49.
Miller SA, Mayer T, Cox R, Gatchel RJ. Reliability problems associated with the modified schober technique for true lumbar flexion measurement. Spine. 1992;17(3):345–8.PubMedCrossRef
50.
Neblett R, Mayer TG, Brede E, Gatchel RJ. Correcting abnormal flexion-relaxation in chronic lumbar pain: responsiveness to a new biofeedback training protocol. Clin J Pain. 2010;26(5):403–9.PubMedPubMedCentralCrossRef
51.
Neblett R, Mayer TG, Brede E, Gatchel RJ. The effect of prior lumbar surgeries on the flexion relaxation phenomenon and its responsiveness to rehabilitative treatment. Spine J. 2014;14(6):892–902.PubMedCrossRef
52.
O'Sullivan P, Smith A, Beales D, Straker L. Understanding adolescent Low Back pain from a multidimensional perspective: implications for management. J Orthop Sports Phys Ther. 2017;47(10):741–51.PubMedCrossRef
53.
Deyo R, Bryan M, Comstock B, Turner J, Heagerty P, Friedly J, Avins A, Nedeljkovic S, Nerenz D, Jarvik J. Trajectories of symptoms and function in older adults with Low Back disorders. Spine. 2015;40(17):1352–62.PubMedCrossRef
54.
O'Sullivan PB. Diagnosis and classification of chronic low backpain disorders: maladaptive movement and motor control impairments as underlying mechanism. Manual Ther. 2005;10:242–55.CrossRef
55.
Sahrmann S. Movement impairment syndromes of the lumbar Spine. In: Diagnosis and treatment of movement impairment syndromes. In: Diagnosis and treatment of movement impairment syndromes. 1st ed. St. Loius: Mosby Inc; 2002. p. 5–118.
56.
Alschuler KN, Neblett R, Wiggert E, Haig AJ, Geisser ME, Alschuler KN, Neblett R, Wiggert E, Haig AJ, Geisser ME. Flexion-relaxation and clinical features associated with chronic low back pain: a comparison of different methods of quantifying flexion-relaxation. Clin J Pain. 2009;25(9):760–6.PubMedCrossRef
57.
58.
Carroll LJ, Cassidy JD, Cote P. Depression as a risk factor for onset of an episode of troublesome neck and low back pain. Pain. 2004;107(1–2):134–9.PubMedCrossRef
59.
Turner JA, Franklin G, Heagerty PJ, Wu R, Egan K, Fulton-Kehoe D, Gluck JV, Wickizer TM. The association between pain and disability. Pain. 2004;112(3):307–14.PubMedCrossRef
60.
Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine. 2004;29(23):2593–602.PubMedCrossRef
61.
Charry E, Umer M, Taylor S. Design and validation of an ambulatory inertial system for 3-D measurements of low back movements. Proceedings of Seventh International Conference on Intelligent Sensors, Sensor Networks and Information Processing (ISSNIP 2011) IEEE Conference Publications. 2011. https://​ieeexplore.​ieee.​org/​document/​6146618.
62.
Ha TH, Saber-Sheikh K, Moore AP, Jones MP. Measurement of lumbar spine range of movement and coupled motion using inertial sensors - a protocol validity study. Man Ther. 2012.
Metadata
Title
Does movement matter in people with back pain? Investigating ‘atypical’ lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors
Authors
Robert A. Laird
Jennifer L. Keating
Kasper Ussing
Paoline Li
Peter Kent
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2387-x

Other articles of this Issue 1/2019

BMC Musculoskeletal Disorders 1/2019 Go to the issue

Research article

Proximal radius fracture morphology following axial force impact: a biomechanical evaluation of fracture patterns

Research article

The influence of ageing on the incidence and site of trauma femoral fractures: a cross-sectional analysis

Research article

Relationship between X-ray findings of lumbar spondylosis and knee pain

Research article

Gluteus medius muscle function in people with and without low back pain: a systematic review

Research article

Timing of periarticular injection has no effect on postoperative pain and functional recovery in simultaneous bilateral total knee arthroplasty: a prospective randomized, double-blinded trial

Research article

Analysis of sagittal alignment parameters following anterior cervical hybrid decompression and fusion of multilevel cervical Spondylotic myelopathy