Subgroups of lumbo-pelvic flexion kinematics are present in people with and without persistent low back pain

Movement dysfunctions have been associated with persistent low back pain (LBP) but optimal treatment remains unclear. One possibility is that subgroups of persistent LBP patients have differing movement characteristics and therefore different responses to interventions. This study examined if there were patterns of flexion-related lumbo-pelvic kinematic and EMG parameters that might define subgroups of movement.

Four subgroups with high probabilities of membership were found (mean 94.9%, SD10.1%). Subgroup 1 (n = 133 people, 26% LBP) had the greatest range of trunk flexion, fastest movement, full flexion relaxation, and synchronous lumbar versus pelvic movement. Subgroup 2 (n = 73, 71% LBP) had the greatest lumbar ROM, less flexion relaxation, and a 0.9 s lag of pelvic movement. Subgroup 3 (n = 41, 83% LBP) had the smallest lumbar ROM, a 0.6 s delay of lumbar movement (compared to pelvic movement), and less flexion relaxation than subgroup 2. Subgroup 4 (n = 19 people, 100% LBP) had the least flexion relaxation, slowest movement, greatest delay of pelvic movement and the smallest pelvic ROM. These patterns could be described as standard (subgroup 1), lumbar dominant (subgroup 2), pelvic dominant (subgroup 3) and guarded (subgroup 4). Significant post-hoc differences were seen between subgroups for most lumbo-pelvic kinematic and EMG parameters. There was greater direction-specific pain and activity limitation scores for subgroup 4 compared to other groups, and a greater percentage of people with leg pain in subgroups 2 and 4.

Four subgroups of lumbo-pelvic flexion kinematics were revealed with an unequal distribution among people with and without a history of persistent LBP. Such subgroups may have implications for which patients are likely to respond to movement-based interventions.