Top

Published in:

Open Access 01-12-2007 | Research article

Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI

Authors: Kornelia Kulig, Christopher M Powers, Robert F Landel, Hungwen Chen, Michael Fredericson, Marc Guillet, Kim Butts

Published in: BMC Musculoskeletal Disorders | Issue 1/2007

Abstract

Background

Altered spinal mobility is thought to be related to current or past episodes of low back pain; however evidence of that relationship in younger subjects has not been established. The purpose of this study was to compare lumbar segmental mobility in asymptomatic and symptomatic subjects during posterior to anterior (PA) manual spinal mobilization and a self-initiated prone press-up (PU) maneuver. We hypothesized that persons with central low back pain would have an altered lumbar segmental mobility pattern compared to those without pain.

Method

Forty-five individuals (age 32.1 ± 8.5) with non-specific low back pain and 20 persons (age 31.1 ± 7.0) without low back pain participated. Each subject underwent dynamic imaging of the lumbar spine during a PA mobilization procedure and while performing a PU. Segmental motion was quantified as the change in the intervertebral angle between the resting and end-range vertebral positions.

Results

The symptomatic group had a larger percentage of subjects with evidence of single level segmental hypermobility than the asymptomatic group during the PA (40.0% vs. 5%) and PU (26.7% vs. 15%) procedures. Single lumbar motion-segment analysis revealed hyper-mobility in symptomatic subjects at L5 – S1 (Chi-square = 10.0, p ≤ 0.01) and L4 – L5 (Chi-square = 4.18, p ≤ 0.05) during the PA test.

Conclusion

Persons with non-specific low back pain have a tendency to demonstrate single level lumbar segmental hypermobility when compared to age specific asymptomatic subjects.

Available only for authorised users

Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C: Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2002, CD000963-

Nickel R, Egle UT, Eysel P, Rompe JD, Zollner J, Hoffmann SO: Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients. Spine. 2001, 26 (20): 2271-2277. 10.1097/00007632-200110150-00020.CrossRefPubMed

Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987, 12 (7 Suppl): S1-59. 10.1097/00007632-198701000-00001.

Frank JW, Kerr MS, Brooker AS, DeMaio SE, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP: Disability resulting from occupational low back pain. Part I: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine. 1996, 21 (24): 2908-2917. 10.1097/00007632-199612150-00024.CrossRefPubMed

Frank JW, Brooker AS, DeMaio SE, Kerr MS, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP: Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine. 1996, 21 (24): 2918-2929. 10.1097/00007632-199612150-00025.CrossRefPubMed

Volinn E: The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries. Spine. 1997, 22 (15): 1747-1754. 10.1097/00007632-199708010-00013.CrossRefPubMed

Walker BF: The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J SPINAL DISORD. 2000, 13 (3): 205-217. 10.1097/00002517-200006000-00003.CrossRefPubMed

McBride D, Begg D, Herbison P, Buckingham K: Low back pain in young New Zealanders. N Z Med J. 2004, 117 (1203): U1099-PubMed

Grotle M, Brox JI, Veierod MB, Glomsrod B, Lonn JH, Vollestad NK: Clinical course and prognostic factors in acute low back pain: patients consulting primary care for the first time. Spine. 2005, 30 (8): 976-982. 10.1097/01.brs.0000158972.34102.6f.CrossRefPubMed

10.

Abbott JH, Fritz JM, McCane B, Shultz B, Herbison P, Lyons B, Stefanko G, Walsh RM: Lumbar segmental mobility disorders: comparison of two methods of defining abnormal displacement kinematics in a cohort of patients with non-specific mechanical low back pain. BMC musculoskeletal disorders [electronic resource]. 2006, 7: 45-10.1186/1471-2474-7-45.CrossRef

11.

Mayer TG, Robinson R, Pegues P, Kohles S, Gatchel RJ: Lumbar segmental rigidity: can its identification with facet injections and stretching exercises be useful?. Archives of physical medicine and rehabilitation. 2000, 81 (9): 1143-1150. 10.1053/apmr.2000.9170.CrossRefPubMed

12.

Panjabi MM: Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003, 13 (4): 371-379. 10.1016/S1050-6411(03)00044-0.CrossRefPubMed

13.

Hicks GE, Fritz JM, Delitto A, Mishock J: Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Archives of physical medicine and rehabilitation. 2003, 84 (12): 1858-1864. 10.1016/S0003-9993(03)00365-4.CrossRefPubMed

14.

Hicks GE, Fritz JM, Delitto A, McGill SM: Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Archives of physical medicine and rehabilitation. 2005, 86 (9): 1753-1762. 10.1016/j.apmr.2005.03.033.CrossRefPubMed

15.

Macrae IF, Wright V: Measurement of lumbar spine motion in population studies. Ann Rheum Dis. 1969, 28 (3): 329-CrossRefPubMedPubMedCentral

16.

Maitland GD: Vertebral Manipulation. 2001, London , Butterworth-Heinemann, 6th

17.

Bjornsdottir SV, Kumar S: Posteroanterior spinal mobilization: state of the art review and discussion. Disabil Rehabil. 1997, 19 (2): 39-46.CrossRefPubMed

18.

Burton AK, Battie MC, Gibbons L, Videman T, Tillotson KM: Lumbar disc degeneration and sagittal flexibility. J SPINAL DISORD. 1996, 9 (5): 418-424. 10.1097/00002517-199610000-00010.CrossRefPubMed

19.

Burton AK, Tillotson KM, Edwards VA, Sykes DA: Lumbar sagittal mobility and low back symptoms in patients treated with manipulation. J SPINAL DISORD. 1990, 3 (3): 262-268. 10.1097/00002517-199009000-00012.CrossRefPubMed

20.

Latimer J, Lee M, Adams R, Moran CM: An investigation of the relationship between low back pain and lumbar posteroanterior stiffness. J Manipulative Physiol Ther. 1996, 19 (9): 587-591.PubMed

21.

Thompson RE, Pearcy MJ, Downing KJ, Manthey BA, Parkinson IH, Fazzalari NL: Disc lesions and the mechanics of the intervertebral joint complex. Spine. 2000, 25 (23): 3026-3035. 10.1097/00007632-200012010-00010.CrossRefPubMed

22.

Twomey LT: A rationale for the treatment of back pain and joint pain by manual therapy. Phys Ther. 1992, 72 (12): 885-892.PubMed

23.

van Tulder MW, Koes BW, Bouter LM: Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine. 1997, 22 (18): 2128-2156. 10.1097/00007632-199709150-00012.CrossRefPubMed

24.

Beneck GJ, Kulig K, Landel RF, Powers CM: The relationship between lumbar segmental motion and pain response produced by a posterior-to-anterior force in persons with nonspecific low back pain. J Orthop Sports Phys Ther. 2005, 35 (4): 203-209. 10.2519/jospt.2005.1479.CrossRefPubMed

25.

Kulig K, Landel R, Powers CM: Assessment of lumbar spine kinematics using dynamic MRI: a proposed mechanism of sagittal plane motion induced by manual posterior-to-anterior mobilization. J Orthop Sports Phys Ther. 2004, 34 (2): 57-64. 10.2519/jospt.2004.1236.CrossRefPubMed

26.

Lee R, Evans J: An in vivo study of the intervertebral movements produced by posteroanterior mobilization. Clin Biomech. 1997, 12 (6): 400-408. 10.1016/S0268-0033(97)00019-3.CrossRef

27.

Powers CM, Kulig K, Harrison J, Bergman G: Segmental mobility of the lumbar spine during a posterior to anterior mobilization: assessment using dynamic MRI. Clin Biomech (Bristol, Avon). 2003, 18 (1): 80-83. 10.1016/S0268-0033(02)00174-2.CrossRef

28.

Dvorak J, Panjabi MM, Novotny JE, Chang DG, Grob D: Clinical validation of functional flexion-extension roentgenograms of the lumbar spine. Spine. 1991, 16 (8): 943-950. 10.1097/00007632-199108000-00014.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/8/8/prepub

Title: Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI
Authors: Kornelia Kulig
Christopher M Powers
Robert F Landel
Hungwen Chen
Michael Fredericson
Marc Guillet
Kim Butts
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2007
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-8-8

ACC 2024 Congress

Springer Medicine

Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI

Abstract

Background

Method

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2007

Biomechanical effects of polyaxial pedicle screw fixation on the lumbosacral segments with an anterior interbody cage support

Adherence to physiotherapy clinical guideline acute ankle injury and determinants of adherence: a cohort study

Knee complaints and consequences on work status; a 10-year follow-up survey among floor layers and graphic designers

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

Design considerations in a clinical trial of a cognitive behavioural intervention for the management of low back pain in primary care: Back Skills Training Trial

Lower back pain in physically demanding college academic programs: a questionnaire based study