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

Robert A Laird,Jayce Gilbert,Peter Kent,Jennifer L Keating

doi:10.1186/1471-2474-15-229

Abstract

BackgroundClinicians 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.MethodsMEDLINE, 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.ResultsThe 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).ConclusionsOn 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.

Highlights

Clinicians commonly examine posture and movement in people with the belief that correcting dysfunctional movement may reduce pain
Observation of lumbo-pelvic movement and posture is a basic component of the physical examination of people with low back pain (LBP) [1,2,3,4] partly due to a common belief held by clinicians that identifying and correcting movement/postural aberration can improve pain and activity limitation [2,5,6]
Search yield The search identified 17,276 potentially relevant articles with 13 articles identified from bibliographies of related articles or other sources

Summary

Introduction

Clinicians commonly examine posture and movement in people with the belief that correcting dysfunctional movement may reduce pain. Observation of lumbo-pelvic movement and posture is a basic component of the physical examination of people with low back pain (LBP) [1,2,3,4] partly due to a common belief held by clinicians that identifying and correcting movement/postural aberration can improve pain and activity limitation [2,5,6]. Measurements reported in studies of lumbo-pelvic kinematics, such as ROM, vary considerably This variability may be due to differences in measurement instruments or methods [11], biological differences in true range of movements, or errors in measurements. Mean scores for extension ranged from 13 ± 8° [13] to 41 ± 10° [15] These large differences between studies are unlikely to be due to biological differences alone. Extreme variations in reported ROM measurements limit confidence in clinical interpretations or treatment decisions based on measurements of an individual

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Conclusion