Abstract
IntroductionGlobally, low back pain (LBP) is one of the greatest causes of disability. In people with LBP, dysfunction of muscles such as the gluteus medius have been demonstrated to increase spinal loading and reduce spinal stability. Differences in gluteus medius function have been reported in those with LBP compared to those without, although this has only been reported in individual studies. The aim of this systematic review was to determine if adults with a history, or current LBP, demonstrate differences in measures of gluteus medius function when compared to adults without LBP.MethodsMEDLINE, EMBASE, AMED, PsycINFO, PubMED, Pro Quest Database, CINAHL and SPORTDiscus were searched from inception until December 2018 for published journal articles and conference abstracts. No language restrictions were applied. Only case-control studies with participants 18 years and over were included. Participants could have had any type and duration of LBP. Studies could have assessed gluteus medius function with any quantifiable clinical assessment or measurement tool, with the participant non-weight bearing or weight bearing, and during static or dynamic activity. Quality appraisal and data extraction were independently performed by two authors.ResultsThe 24 included articles involved 1088 participants with LBP and 998 without LBP. The gluteus medius muscle in participants with LBP tended to demonstrate reduced strength and more trigger points compared to the gluteus medius muscle of those without LBP. The level of activity, fatigability, time to activate, time to peak activation, cross sectional area, and muscle thickness showed unclear results. Meta-analysis was not performed due to the heterogeneity of included studies.ConclusionClinically, the findings from this systematic review should be considered when assessing and managing patients with LBP. Future studies that clearly define the type and duration of LBP, and prospectively assess gluteus medius muscle function in those with and without LBP are needed.Trial registrationPROSPERO (CRD42017076773).
Highlights
Low back pain (LBP) is one of the greatest causes of disability
The gluteus medius muscle in participants with low back pain (LBP) tended to demonstrate reduced strength and more trigger points compared to the gluteus medius muscle of those without LBP
Individuals with LBP are more likely to exhibit reduced gluteus medius muscle strength [4], reduced hip abduction force output [5], and altered hip muscle recruitment, demonstrating a distal-to-proximal muscle activation pattern in the lower limb compared to proximal-todistal in healthy controls [6]. These alterations to gluteus medius muscle function and strength have been suggested to lead to LBP [7], it is unknown whether such muscle deconditioning or atrophy is the cause or result of symptomatic LBP
Summary
Low back pain (LBP) is one of the greatest causes of disability. In people with LBP, dysfunction of muscles such as the gluteus medius have been demonstrated to increase spinal loading and reduce spinal stability. Individuals with LBP are more likely to exhibit reduced gluteus medius muscle strength [4], reduced hip abduction force output [5], and altered hip muscle recruitment, demonstrating a distal-to-proximal muscle activation pattern in the lower limb compared to proximal-todistal in healthy controls [6]. These alterations to gluteus medius muscle function and strength have been suggested to lead to LBP [7], it is unknown whether such muscle deconditioning or atrophy is the cause or result of symptomatic LBP. Gluteus medius weakness and consequential loss of dynamic lateral stability of the pelvis and lower back is suggested to lead to increased lateral trunk flexion and subsequent intervertebral disc compression [10], as well as altered movement patterns which may contribute to the development or exacerbation of LBP during standing [11,12,13,14,15]
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