Abstract
BackgroundChronic low back pain (cLBP) affects millions of Americans and costs billions. Studies suggest a link between cLBP and joint hypermobility.MethodsWe conducted cross-sectional primary analyses of joint hypermobility and cLBP, lumbar spine osteoarthritis (OA), and lumbar facet joint OA (FOA) in 3 large studies—the Generalized Osteoarthritis Study, Genetics of Generalized Osteoarthritis Study, and Johnston County Osteoarthritis Project (total n = 5072). Associations of joint hypermobility and Beighton trunk flexion with cLBP and lumbar OA were estimated using separate adjusted logistic regression models. Adjusted pooled odds ratios (pORs) and 95% confidence intervals (CIs) were then summarized—using random effect univariate, multivariate crude, and adjusted models—and heterogeneity was determined (I2 statistic).ResultsIn univariate models, hypermobility was associated with symptomatic FOA (pOR = 0.64 [95% CI 0.44, 0.93]) but this result was not found in the multivariate models. In multivariate adjusted models, hypermobility was not significantly associated with cLBP and lumbar OA, but trunk flexion was inversely associated with cLBP (pOR = 0.40 [95% 0.26, 0.62]), spine OA (pOR = 0.66 [95% CI 0.50, 0.87]), symptomatic spine OA (pOR = 0.39 [95% CI 0.28, 0.53]), and symptomatic FOA (pOR = 0.53 [95% CI 0.37, 0.77]). Generally, between-study heterogeneity was moderate-high.ConclusionsHypermobility was not associated with cLBP or lumbar OA. The inverse association of trunk flexion with cLBP and lumbar OA may indicate a role for a flexible spine in avoiding or managing these conditions.
Highlights
Chronic low back pain affects millions of Americans and costs billions
One prior cohort study has examined the association of joint hypermobility and lumbar spine disorders, but it was limited because only one participant had a Beighton Score ≥ 4/9 [19]
Regulatory restrictions preventing pelvic radiographs at some sites in this multi-site study were primarily responsible for missing lumbar spine radiographs from the Genetics of Generalized Osteoarthritis (GOGO) study
Summary
Chronic low back pain (cLBP) affects millions of Americans and costs billions. Chronic low back pain (cLBP) affects more than 31 million Americans at any given time [1], has increased threefold in prevalence in a 10-year period [2], and results in $100–$200 billion per year in expenditures [3]. A large amount of these expenditures are attributed to 2 conditions associated with cLBP: intervertebral disc degeneration (IDD) and facet joint osteoarthritis (FOA) [4,5,6,7,8,9,10]. The purpose of this study was to examine the association of joint hypermobility and clinically relevant lumbar spine outcomes of pain, radiographic spine OA and FOA, and symptomatic spine OA or FOA in 3 large studies. We hypothesized that joint hypermobility would be associated with prevalent lumbar spine outcomes
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