Regional differences in lumbar spinal posture and the influence of low back pain

Tim Mitchell,Angus F Burnett,Anne Smith,Leon Straker,Peter B O'Sullivan

doi:10.1186/1471-2474-9-152

Tim Mitchell, Angus F Burnett + Show 3 more

Open Access

https://doi.org/10.1186/1471-2474-9-152

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Abstract

BackgroundSpinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP.MethodsOne hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx), Upper lumbar (ULx) and total lumbar (TLx) spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks.ResultsRegional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638), but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p < 0.001). Regional differences in range of motion from reference postures in sitting and standing were evident. BMI accounted for regional differences found in all sitting and some standing measures. LBP was not associated with differences in regional lumbar spine angles or range of motion, with the exception of maximal backward bending range of motion (F = 5.18, p = 0.007).ConclusionThis study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.

Highlights

Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients
Retraining "ideal" spinal posture is a common component of the clinical management
2. if the nature of these differences are similar in subjects with and without a history of LBP. Design This cross-sectional study was part of a larger prospective study into patterns of LBP in nursing students. This current study examined the LBP characteristics and spinal kinematics across a range of static postures and functional tasks of female undergraduate nursing students

Summary

Introduction

Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. BMC Musculoskeletal Disorders 2008, 9:152 http://www.biomedcentral.com/1471-2474/9/152 of non-specific LBP patients [3,4], the direct relationship between spinal posture and LBP still remains unclear. Evidence of both a relationship [5,6], or no relationship [7,8] between posture and LBP has been reported in previous in-vivo posture studies. LBP patients report more pain in the lower lumbar (LLx) spinal segments than upper lumbar (ULx) segments [10,11] This is consistent with a greater degree of degeneration being evident in the LLx spinal segments [12,13], which is thought to be due to the greater mechanical stress through these segments [14]. Given some individual lumbar spinal segments show greater degenerative changes than other lumbar segments, the notion of the lumbar spine as a homogenous region may not provide a true reflection of pain and function in this region

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