Abstract
BackgroundIntervertebral motion impairment is widely thought to be related to chronic back disability, however, the movements of inter-vertebral pairs are not independent of each other and motion may also be related to morphology. Furthermore, maximum intervertebral range of motion (IV-RoMmax) is difficult to measure accurately in living subjects. The purpose of this study was to explore possible relationships between (IV-RoMmax) and lordosis, initial attainment rate and IV-RoMmax at other levels during weight-bearing flexion using quantitative fluoroscopy (QF).MethodsContinuous QF motion sequences were recorded during controlled active sagittal flexion of 60° in 18 males (mean age 27.6 SD 4.4) with no history of low back pain in the previous year. IV-RoMmax, lordotic angle, and initial attainment rate at all inter-vertebral levels from L2-S1 were extracted. Relationships between IV-RoMmax and the other variables were explored using correlation coefficients, and simple linear regression was used to determine the effects of any significant relationships. Within and between observer repeatability of IV-RoMmax and initial attainment rate measurements were assessed in a sub-set of ten participants, using the intra-class correlation coefficient (ICC) and standard error of measurement (SEM).ResultsQF measurements were highly repeatable, the lowest ICC for IV-RoMmax, being 0.94 (0.80–0.99) and highest SEM (0.76°). For initial attainment rate the lowest ICC was 0.84 (0.49–0.96) and the highest SEM (0.036). The results also demonstrated significant positive and negative correlations between IV-RoMmax and IV-RoMmax at other lumbar levels (r = −0.64–0.65), lordosis (r = −0.52–0.54), and initial attainment rate (r = −0.64–0.73). Simple linear regression analysis of all significant relationships showed that these predict between 28 and 42 % of the variance in IV-RoMmax.ConclusionsThis study found weak to moderate effects of individual kinematic variables and lumbar lordosis on IV-RoMmax at other intervertebral levels. These effects, when combined, may be important when such levels are being considered by healthcare professionals as potential sources of pain generation. Multivariate investigations in larger samples are warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0975-1) contains supplementary material, which is available to authorized users.
Highlights
Intervertebral motion impairment is widely thought to be related to chronic back disability, the movements of inter-vertebral pairs are not independent of each other and motion may be related to morphology
The investigation of spinal mechanical behaviour has been outlined as a priority for future quantitative fluoroscopy (QF) research [21], which begins with the relationships between inter-vertebral range of motion (IV-RoM) and other kinematic variables in healthy, pain–free control populations
It has been demonstrated that reliability and agreement are typically decreased in the interobserver group [11, 14], these differences were shown to be minimal in the current study, and there were notable exceptions to the trend (Table 2)
Summary
Intervertebral motion impairment is widely thought to be related to chronic back disability, the movements of inter-vertebral pairs are not independent of each other and motion may be related to morphology. As a consequence of their wide variation in both low back pain and healthy populations the clinical importance of factors such as inter-vertebral range of motion (IV-RoM) remains unclear, and the identification of biomechanical factors that may contribute to low back pain, remains a challenge [11]. The investigation of spinal mechanical behaviour has been outlined as a priority for future QF research [21], which begins with the relationships between IV-RoM and other kinematic variables in healthy, pain–free control populations. Such normative information should provide insights into the possible biomechanical consequences of changes within each
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