Elsevier

Clinical Biomechanics

Volume 24, Issue 1, January 2009, Pages 7-12
Clinical Biomechanics

Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests

https://doi.org/10.1016/j.clinbiomech.2008.09.008Get rights and content

Abstract

Background

Clinical data suggest that active limb movements may be associated with early lumbopelvic motion and increased symptoms in people with low back pain.

Methods

Forty-one people without low back pain who did not play rotation-related sports and 50 people with low back pain who played rotation-related sports were examined. Angular measures of limb movement and lumbopelvic motion were calculated across time during active knee flexion and active hip lateral rotation in prone using a three-dimensional motion capture system. Timing of lumbopelvic motion during the limb movement tests was calculated as the difference in time between the initiation of limb movement and lumbopelvic motion normalized to limb movement time.

Findings

During knee flexion and hip lateral rotation, people with low back pain demonstrated a greater maximal lumbopelvic rotation angle and earlier lumbopelvic rotation, compared to people without low back pain (P < 0.05).

Interpretation

The data suggest that people with low back pain who play rotation-related sports may move their lumbopelvic region to a greater extent and earlier during lower limb movements than people without low back pain. Because people perform many of their daily activities in early to midranges of joint motion the lumbopelvic region may move more frequently across the day in people with low back pain. The increased frequency may contribute to increased lumbar region tissue stress and potentially low back pain symptoms. Lower limb movements, therefore, may be important factors related to the development or persistence of low back pain.

Introduction

Limb movements result in forces on the spine and could, therefore, affect the lumbopelvic region. Some investigators have studied the effect of active, voluntary limb movements on the trunk, comparing people with and people without low back pain (LBP). Many of these investigators have focused on postural responses with rapid limb movements in standing, examining anticipatory trunk muscle activity (Bouisset and Zattara, 1981, Friedli et al., 1984, Hodges and Richardson, 1996, Hodges and Richardson, 1997, Hodges and Richardson, 1998, Hodges and Richardson, 1999), as well as preparatory trunk and hip movement (Mok et al., 2007). Lumbar region and hip joint kinematics have been studied with bending forward in standing and during a few everyday activities in people with and people without LBP (Esola et al., 1996, Mok et al., 2007, Porter and Wilkinson, 1997, Shum et al., 2005a, Shum et al., 2005b). The effect of active, voluntary limb movements on lumbopelvic kinematics during standardized limb movement tests, however, has not been extensively studied. These limb movement tests are considered important because clinical data suggest that active limb movements performed during standardized limb movement tests can be associated with (1) early lumbopelvic motion in people with LBP (Scholtes and Van Dillen, 2007), (2) an increase in LBP symptoms during preferred movement (Van Dillen et al., 2001), and (3) a decrease in LBP symptoms (Van Dillen et al., 2003a, Van Dillen et al., 2007b) when lumbopelvic motion is modified during limb movements. In addition, intervention that includes exercise to modify lumbopelvic movement patterns with limb movements appears to contribute to positive short- and long-term outcomes (Harris-Hayes et al., 2005, Maluf et al., 2000, Scholtes et al., 2006, Van Dillen et al., 2005).

Lumbopelvic motion that occurs early during an active, voluntary limb movement is considered to be important because people perform many of their daily activities in early to midranges of joint motion. It has been proposed that, if the lumbopelvic region moves during the early ranges of a limb movement, then the frequency of lumbopelvic motion may be increased across the day. The increased frequency of lumbopelvic motion may contribute to increased tissue stress in the lumbopelvic region (Adams et al., 2002), particularly if the lumbopelvic motion is always in the same direction. With time, the increase in stress may contribute to cumulative microtrauma, tissue failure, and the development of LBP symptoms (Adams et al., 2002, McGill, 1997). Previously, investigators have reported on differences in timing of lumbopelvic motion between LBP subgroups (Van Dillen et al., 2007a) and between men and women (Gombatto et al., 2006) during the active limb movement test of hip lateral rotation in prone. To our knowledge, however, no studies have examined differences in timing of lumbopelvic motion between people with and people without LBP during active, voluntary limb movement tests. Examining differences between people with and people without LBP in timing of lumbopelvic motion may provide insight into the importance of early lumbopelvic motion to the development, persistence, or recurrence of a LBP problem. Furthermore, identifying differences between people with and people without LBP highlights the importance of the previously identified LBP subgroup differences with the test of hip lateral rotation (Gombatto et al., 2006, Van Dillen et al., 2007a).

The purpose of the current study was to examine timing of lumbopelvic motion between people with and people without LBP during two active lower limb movement tests. It was hypothesized that, compared to people without LBP, people with LBP would demonstrate earlier lumbopelvic motion during two active lower limb movement tests performed in prone: knee flexion and hip lateral rotation. Identifying differences in timing of lumbopelvic motion between people with and people without LBP during lower limb movement tests may lead to improved understanding of the factors contributing to LBP and help refine LBP intervention strategies.

Section snippets

Subjects

Forty-one subjects without LBP who did not regularly participate in a rotation-related sport and 50 subjects with LBP who regularly (minimum of two times per week) participated in a rotation-related sport were enrolled in the study. Table 1 includes subject and LBP-related characteristics of the sample. A rotation-related sport was defined as a sport that required repeated rotation of the trunk and hips to perform most aspects of the activity (e.g. tennis and racquet ball). All subjects with

Results

There were no differences between people with and people without LBP in sex distribution, age, BMI, or activity level (Table 1).

Discussion

The purpose of the current study was to examine differences in timing of lumbopelvic motion between people with and people without LBP during two lower limb movement tests. Consistent with our hypotheses, compared to people without LBP who do not regularly participate in rotation-related sports, people with LBP who regularly participate in rotation-related sports demonstrated earlier lumbopelvic motion during KF and HLR. Although we did not hypothesize group differences in lumbopelvic angle

Conclusion

The current findings suggest that a greater magnitude of and earlier lumbopelvic motion in the transverse plane during lower limb movements may be important factors contributing to the development or persistence of a LBP problem in people who regularly participate in rotation-related sports. Future work should focus on identifying (1) the factors that contribute to the increased and earlier lumbopelvic motion identified in people with LBP in the current study and (2) whether similar movement

Conflict of Interest Statement

The authors acknowledge that we do not have any financial or personal relationships with other people or organizations that could inappropriately influence the work described in the current manuscript.

Funding Sources

This work was funded in part by the National Institute of Child Health and Human Development, National Center for Medical Rehabilitation Research, Grant Nos. K01HD-01226, 5 R01 HD047709, and T32HD007434, as well as a scholarship from the Foundation for Physical Therapy, Inc. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD, NIH, or the Foundation for Physical Therapy.

Acknowledgements

We would like to acknowledge Jack Engsberg, Ph.D. for his assistance with project planning and David Collins, Ph.D. for his assistance with data processing.

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