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Background
Clinicians 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 studi...
Citations
... Clinical observation of movement control and coordination during active forward bending of the trunk is one critical part of the physical examination for patients with low back pain (LBP) [1][2][3]. Aberrant movement patterns during active forward bending cause shear forces and suboptimal tissue loading at the spine resulting in an increased risk of tissue damage [1,4,5]. Aberrant movement patterns have consistently been identified in individuals with a history of LBP, and investigators have speculated that this could be due to unresolved lumbar multifidus (LM) muscle dysfunction [1,4,6]. ...
Background
Instability catch (IC) during active forward bending is an aberrant movement pattern observed in patients with low back pain. Increasing load and speed may show different responses in kinematics and motor unit behavior including peak amplitudes (pAMP) and mean firing rates (mFR).
Objectives
This study aimed to compare kinematic patterns under different loads and speeds and explored the motor unit behavior in individuals with and without IC.
Methods
17 participants were classified as having IC and 10 participants were classified as having no IC from clinical observations. Inertial measurement units were used to quantify kinematic parameters, and decomposition electromyography (dEMG) was used to investigate motor unit behavior. Participants performed 2 sets of 1-minute forward bending under low load and low speed (LL), high load and low speed (HL), and low load and high speed (LH) conditions.
Results
Significant between-group differences (P < 0.05) were found in kinematic parameters. Significant within-group changes (P < 0.05) were found between the LL and HL conditions for all kinematic parameters in individuals with IC. Individuals without IC demonstrated significant within-group changes (P < 0.05) between LL and LH in mFR, while individuals without IC showed changes in both pAMP and mFR.
Conclusion
These kinematic parameters may represent IC. Changes in motor unit behavior suggest that individuals with and without IC used different strategies to perform this task. Clinicians may consider varying the speed of movement to challenge the trunk neuromuscular control system and design interventions to address motor unit firing rate.
... Participants with medium to high pain showed a reduced trunk RoM compared to asymptomatic controls, due to a lower trunk angle at the end of the forward flexion, but without differences in lumbar lordosis or pelvic rotation. Similarly, other studies (53,55) observed no differences in lumbar lordosis and pelvic angle between participants with and without low-back pain. Some previous studies have reported an effect of low-back pain on the lumbopelvic ratio, with a relatively greater lumbar contribution during full trunk flexion in participants with low-back pain (19,22,94). ...
... When classifying patients with low-back pain into specific subgroups, Kim et al. (21) found differences in the lumbo-pelvic ratio between healthy participants and specific subgroups of lowback pain. It has therefore been suggested, that the relative contributions of the lumbar spine and the pelvis to a flexion movement may be of clinical relevance (55) with applications in diagnostics (19,21,22,95), load and injury-risk estimation (13)(14)(15)(16) and therapy of low-back pain (17,18). When pooling data from previous experimental studies in a meta-analytic approach, Laird et al. (55), similar to our study with the large number of participants, found no significant differences in lumbo-pelvic coordination for participants with and without lowback pain. ...
... It has therefore been suggested, that the relative contributions of the lumbar spine and the pelvis to a flexion movement may be of clinical relevance (55) with applications in diagnostics (19,21,22,95), load and injury-risk estimation (13)(14)(15)(16) and therapy of low-back pain (17,18). When pooling data from previous experimental studies in a meta-analytic approach, Laird et al. (55), similar to our study with the large number of participants, found no significant differences in lumbo-pelvic coordination for participants with and without lowback pain. In our study, participants with low to medium pain intensity had a reduced lumbar spine angle when standing upright compared to both asymptomatic controls and participants with medium to high pain intensity. ...
Background
Trunk posture and lumbo-pelvic coordination can influence spinal loading and are commonly used as clinical measures in the diagnosis and management of low-back pain and injury risk. However, sex and pain specific characteristics have rarely been investigated in a large cohort of both healthy individuals and low-back pain patients. It has also been suggested that the motor control of trunk stability and trunk movement variability is altered in individuals with low-back pain, with possible implications for pain progression. Nonetheless, clear links to low-back pain are currently lacking.
Objective
To investigate trunk posture, lumbo-pelvic coordination, trunk dynamic stability and trunk movement variability in an adequately large cohort of individuals with low-back pain and asymptomatic controls and to explore specific effects of sex, pain intensity and pain chronicity.
Methods
We measured lumbo-pelvic kinematics during trunk flexion and trunk dynamic stability and movement variability during a cyclic pointing task in 306 adults (156 females) aged between 18 and 64 years, reporting either no low-back pain or pain in the lumbar area of the trunk. Participants were grouped based on their characteristic pain intensity as asymptomatic (ASY, N = 53), low to medium pain (LMP, N = 185) or medium to high pain (MHP, N = 68). Participants with low-back pain that persisted for 12 weeks or longer were categorized as chronic (N = 104). Data were analyzed using linear mixed models in the style of a two way anova.
Results
Female participants showed a higher range of motion in both the trunk and pelvis during trunk flexion, as well as an increased lumbar lordosis in standing attributed to a higher pelvic angle that persisted throughout the entire trunk flexion movement, resulting in a longer duration of lumbar lordosis. The intensity and chronicity of the pain had a negligible effect on trunk posture and the lumbo-pelvic coordination. Pain chronicity had an effect on trunk dynamic stability (i.e., increased trunk instability), while no effects of sex and pain intensity were detected in trunk dynamic stability and movement variability.
Conclusions
Low-back pain intensity and chronicity was not associated with lumbo-pelvic posture and kinematics, indicating that lumbo-pelvic posture and kinematics during a trunk flexion movement have limited practicality in the clinical diagnosis and management of low-back pain. On the other hand, the increased local instability of the trunk during the cyclic coordination task studied indicates control errors in the regulation of trunk movement in participants with chronic low-back pain and could be considered a useful diagnostic tool in chronic low-back pain.
... 13,[16][17][18] People with low back pain (LBP) exhibit differences in their lumbar position sense compared to those without LBP, 19 although some studies have not found any deficits. 20,21 Research suggests that when movements are initiated voluntarily, centrally generated signals from motor commands and perceived effort contribute to kinaesthetic awareness. 22 A hypothesis suggests that Kinesiophobia could influence somatosensory changes, impacting the musculotendinous and capsule-ligamentous structures. ...
Background
Chronic lower back pain condition (CLBP) was reported with a significantly higher disability levels and fear-avoidance beliefs than their asymptomatic counterparts. However, the anecdotal evidence is there to support whether kinesiophobia had impacted the level of lumbar position sense among CLBP. The aim of the study was to analyze the relation between kinesiophobia, and lumbar position sense in patients with CLBP and asymptomatic individual.
Methods
This is part of a major case-control study proceeded with 200 patients with CLBP and 400 controls. Kinesiophobia, and lumbar position sense were assessed with Tampa Scale for Kinesiophobia, and lumbar re-positioning test, respectively. Functional ability was measured with a patient- specific Functional Scale in patients with CLBP. Regression models was administered to explore the complex relation between kinesiophobia, and lumbar position sense.
Results
Kinesiophobia was reported high among patients with CLBP (30%) than in controls (11%) with the mean difference of 6.49 ± 0.52, d = 1.07 and lumbar position sense (0.09) were positively correlated with kinesiophobia.
Discussion and conclusion
Although a higher rate of kinesiophobia was reported among patients with CLBP when compared to controls, majority of cases with CLBP did not report Kinesiophobia. Further, Kinesiophobia was found to influence lumbar position sense among patients with CLBP.
ClinicalTrials.gov Identifier: NCT05079893 Registered on 14/10/2021.
... In the spine, motor control refers to 'movement quality' such as spinal range of motion (ROM) and trunk muscle activity. Many people with LBP demonstrate altered movement patterns compared to healthy individuals (Errabity et al. 2023;Laird et al. 2014Laird et al. , 2019, which may contribute to persistent pain and disability via sub-optimal tissue loading during movement and exercise (Hodges and Smeets 2015;Hodges and Tucker 2011). A systematic review found weak evidence linking low spinal ROM and increased disability in chronic and acute LBP, highlighting decreased ROM as a possible treatment target in some, but likely not all, LBP patients (Nzamba et al. 2024). ...
... They had moderate kinesiophobia (Chimenti et al. 2021) and greater self-efficacy than chronic LBP patients (Lacasse et al. 2015). Motor behaviours, including ROM and muscle relaxation (FRP ratios), were similar to healthy individuals (Gouteron et al. 2022;Laird et al. 2014;Thomas et al. 1998). Clinically, they had minimal disability, moderate pain intensity and low pain during movement. ...
Background
Clustering helps identify patient subgroups with similar biopsychosocial profiles in acute low‐back pain (LBP). Motor factors are common treatment targets and are associated with disability but have not been included in acute LBP cluster development. This study aimed to identify subgroups of individuals with acute LBP based on motor, sensory and psychological characteristics and to compare these subgroups regarding clinical outcomes.
Methods
Ninety‐nine participants with acute LBP were recruited, and motor (bending range of motion [ROM], flexion relaxation), pain sensitivity (pressure‐pain thresholds, temporal summation of pain) and psychological factors (pain catastrophising, kinesiophobia, self‐efficacy) were measured, along with pain, disability and demographics.
Results
Principal component analysis accounted for 66.03% of the variance. Four component scores were entered in a hierarchical linear clustering model, deriving 3 subgroups (‘mild features’ n = 39, ‘sensorimotor’ n = 35 and ‘psychomotor’ n = 25). Between‐cluster comparisons revealed significant differences in motor, sensory and psychological variables ( p < 0.05). Sensorimotor and psychomotor clusters had higher flexion–relaxation ratios (mean difference: > 0.2), greater disability (mean difference: > 7/100) and smaller ROM (mean difference: 7 cm) compared to the ‘mild’ group. The sensorimotor cluster mostly exhibited higher temporal summation of pain (mean difference: > 1.3/10) and lower pressure‐pain thresholds (mean difference: > 1.2 kg/cm ² ) than ‘mild’ and psychomotor clusters. The psychomotor cluster showed higher kinesiophobia (mean difference: > 6/44) and pain catastrophising (mean difference: > 12/52) than ‘mild’ and sensorimotor groups.
Conclusion
Findings indicate 3 subgroups, suggesting that motor factors may add granularity to acute LBP clusters. Stratified care based on these subgroups may help refine treatment pathways for acute LBP.
Significance Statement
Including motor factors in cluster development adds a clinically relevant metric to describe people with acute LBP and generates insight into underlying mechanisms of motor adaptation. Longitudinal testing is required to see if these subgroups are differentially related to short‐ and long‐term pain and disability.
... However, unexpectedly, the anterior shift we found was only demonstrated in the group of participants who did not recover. Given the role of the primary motor cortex in motor control (Bhattacharjee et al. 2021) and the differences in motor control in people with LBP compared to people without LBP (Hadizadeh et al. 2014;Laird et al. 2014;Rausch Osthoff et al. 2015;Tong et al. 2017;Willigenburg et al. 2013), it is assumed that changes in the organization of the primary motor cortex occur to prevent (further) pain through adapted motor control . In this context, it seems logical that recovery from pain might involve changes in the organization of the primary motor cortex that move opposite to the baseline measurement, as reflected in cortical area or CoG. ...
The evidence for primary motor cortex reorganization in people with low back pain varies and is conflicting. Little is known about its association with motor and sensory tests, and recovery. We investigated primary motor cortex (re)organization and its associations with motor and sensory tests over time in people with ( N = 25) and without ( N = 25) low back pain in a longitudinal study with a 5‐week follow‐up. Participants with low back pain received physical therapy. Primary motor cortex organization, including the center of gravity and area of the cortical representation of trunk muscles, was evaluated using neuronavigated transcranial magnetic stimulation, based on individual magnetic resonance imaging. A motor control test (spiral tracking test) and sensory tests (quantitative sensory testing, graphaesthesia, and 2‐point discrimination) were administered. Multivariate mixed models with a 3‐level structure were used. In non‐recovered participants, the center of gravity of longissimus L5 moved significantly anterior, and their temporal summation of pain decreased significantly more than in people without low back pain. The spiral tracking path length decreased significantly in participants without low back pain, which differed significantly from the increase in recovered participants. Significant associations were found between center of gravity and area with quantitative sensory tests and the spiral tracking test. We found a limited number of significant changes and associations over time, mainly related to longissimus L5. For some of these findings, no logical explanation seems currently available. Hence, it is unclear whether meaningful changes in cortical organization occur in people with low back pain over a 5‐week period.
... 12 Physical factors, for instance, may serve as potential biomarkers that help differentiate individuals with LBP from asymptomatic populations 13 and may have relevance for acute exacerbation and repeated episodes of pain. Physical factors include aspects such as muscle strength and endurance, 14 15 changes in the quantity and quality of spinal movement [16][17][18][19] and deficits in proprioception and movement precision. [19][20][21][22] Furthermore, people with LBP often present with altered muscle activity, [23][24][25] including increased trunk ...
Introduction
Low back pain (LBP) is a global health concern. Approximately two-thirds of those who recover from LBP experience a relapse within a year, with many chronic cases encountering acute flare-ups (exacerbation). This systematic review will synthesise and analyse whether physical and/or psychological features can predict recurrent episodes of LBP or exacerbation of pain.
Methods and analysis
This systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Comprehensive literature searches will be conducted in MEDLINE, EMBASE, APA PsycInfo, PubMed, CINAHL Plus, Web of Science, Scopus and ZETOC, spanning from each database’s inception through to January 2025. Google Scholar and grey literature sources, including OpenGrey, will also be searched to ensure comprehensive coverage. Two independent reviewers will screen titles, abstracts and full texts, assessing the risk of bias with a modified Quality in Prognosis Studies tool. The overall certainty of evidence will be evaluated using an adapted Grading of Recommendations Assessment, Development and Evaluation approach. If sufficient data homogeneity is present, a meta-analysis will be performed; otherwise, findings will be synthesised narratively. The results will identify the ability of physical and/or psychological factors to predict pain recurrence or acute exacerbation in case of persistent non-specific LBP.
Ethics and dissemination
This study protocol does not present any ethical concerns. The findings from the systematic review will be submitted for publication in a peer-reviewed journal and will also be presented at relevant conferences.
PROSPERO registration number
CRD42024599514.
... Cluster 3 was a subgroup with high trunk muscle mass, LPPT, sympathetic activity, and low lumbar proprioception. The reason for no significant difference in lumbar proprioception could be due to sample size, and this result is consistent with that of previous studies [37], which showed that proprioception-based control is less likely to occur when the sympathetic nervous system is dominant. ...
Background/Objectives: Chronic low back pain (CLBP) after middle age is a complex multifactorial condition, and subgrouping is recommended to determine effective treatment strategies. Multidimensional data help create new groupings to increase the effectiveness of interventions in middle-aged and older adults with CLBP. This study aimed to investigate the relationship between the factors associated with CLBP after middle age and to create and characterize a new subgroup based on these factors. Methods: A cross-sectional observational study was conducted and included 46 women aged ≥40 years with CLBP who participated in health events. Trunk muscle mass, lumbar movement control ability, autonomic balance, lumbar tenderness threshold, lumbar proprioception, and severity of central sensitization were assessed. Results: Partial correlation analysis revealed a significant negative correlation between lumbar movement control ability and autonomic balance. A significant positive correlation was observed between trunk muscle mass and the lumbar tenderness threshold. Hierarchical clustering analysis identified three subgroups. The cluster 1 participants had low trunk muscle mass, low tenderness threshold, and low severity of central sensitization. The cluster 2 participants had low trunk muscle mass and tenderness threshold and high severity of central sensitization. The cluster 3 participants had high trunk muscle mass and tenderness threshold and were sympathetically predominant. Trunk muscle mass, pressure pain threshold, severity of central sensitization, and autonomic balance were significantly different between the clusters. Conclusions: Three characteristic subgroups were identified. The results contribute to treatment and prevention strategies for middle-aged and older adults with CLBP based on the characteristics of the subgroups rather than a uniform approach.
... Some of the guidance in the health education section of the care pathway, such as postural correction for daily activities and full adherence to the treatment plan, are not covered by the international guidelines used as references in this study. Although practices such as postural correction are widely used, recent literature suggests that their isolated effectiveness in managing LBP is limited (Laird et al. 2014;Steffens et al. 2016). Similarly, the emphasis on adherence to the treatment plan as the main strategy to prevent the chronicity of LBP does not find strong support in current guidelines, which prioritise a multidisciplinary and individualised approach (Kamper et al. 2015;Oliveira et al. 2018). ...
Background
Primary health care is the gateway to low back pain (LBP) management. Effective management of LBP can reduce disability and socioeconomic burden. Standardised, accurate, and evidence‐based information for assertive decision‐making in care pathways for LBP has the potential to improve health service efficiency.
Objective
To describe and analyse the accuracy of the information on the care pathway for the management of LBP in primary care provided by the Ministry of Health from Brazil.
Methods
Descriptive study of the accuracy of information on the care pathway for LBP in primary care based on an official protocol of the Ministry of Health from Brazil. Information on non‐pharmacological and pharmacological treatment, as well as health education, was extracted from the treatment protocol. The information was then compared with recent international guidelines for accuracy analysis. Each management recommendation was analysed by two independent researchers and classified as accurate, partially accurate, inaccurate or not mentioned according to the clarity and precision of the information.
Results
The analysis revealed that 43% of the management recommendations were accurate, 30% were partially accurate, and 26% of the recommendations presented in the investigated guidelines were not mentioned in the Ministry of Health's care pathway. Pharmacological recommendations showed 50% accuracy, non‐pharmacological recommendations 60%, and health education recommendations 14%. Additionally, the care pathway appears to be outdated in recommending educational guidance that is not aligned with current clinical guidelines.
Conclusion
The results indicate that, although there some aspects of the information provided by the Brazilian official management protocol align with international clinical guidelines, there are substantial gaps, especially in the areas of health education and non‐pharmacological interventions. This study may contribute to making more accurate information available on LBP, bringing primary care professionals in Brazil closer to evidence‐based recommendations.
... In their study, Henry et al. suggested that individuals with CLBP have abnormal automatic postural coordination indicating altered neuromuscular control. 9,20 A comparison of the standing on one leg and Y balance test between healthy individuals and individuals with CLBP showed a performance impairment that may affect spinal stability in individuals with CLBP. 21 In addition, individuals with CLBP can modify their motor control strategies to prevent pain sensation. ...
Çalışmamızın amacı kronik bel ağrısı olan bireyler ile sağlıklı bireylerin skapula pozisyonunu incelemek, denge fonksiyonellik ve propriosepsiyon ile ilişkisini belirlemek amacıyla tasarlanmıştır. Çalışma en az 3 ay süreli ağrı şikâyeti olan kronik bel ağrılı (n=40, yaş: 31.13) ve benzer yaş grubu ve fiziksel özelliklerdeki sağlıklı bireyler (n=41, yaş: 28.37) dahil edildi. Bireylerin ağrı şiddeti vizüel analog skala ve ağrı toleransı algometreyle değerlendirildi. Skapular pozisyon değerlendirmesi için lateral skapular kayma testi uygulandı. Bireylerin günlük yaşam aktivitelerindeki fonksiyonelliği Oswestry Disabilite İndeksi ile değerlendirildi. Bireylerin dinamik ve statik dengelerini değerlendirmek için Biodex Denge Sistemi kullanıldı. Proprioseopsiyonu, gözler açık/kapalı koşullarda lumbal fleksiyon ve ekstansiyon pozisyonlarında inklinometre cihazı kullanılarak ölçüm yapıldı. Çalışma sonucumuzda sağlıklı ve kronik bel ağrılı gruplar arasındaki fark incelendiğinde propriosepsiyon (p=0.084), ağrı toleransı (p=0.64) ve skapula pozisyonu (p=0.570) açısından anlamlı ilişki bulunamamıştır. Ancak bireyler arasında sol ayak dinamik (p=0.036) ve statik (p=0.035) ve dinamik çift ayak (p=0.039) dengede anlamlı fark bulunmuştur. Çalışma sonucunda elde edilen bulgulara göre kronik bel ağrısı olan bireyler ve benzer yaş grubundaki bireylerde arasında denge parametrelerde farklılık bulundu. Ancak skapula poziyonu, ağrı ve propriosepsiyon arasında farklılıklar bulunmadı. Gelecekte daha ileri yaş grupkarıyla yapılan çalışmalarda daha etkili sonuçlar elde edileceği düşüncesindeyiz.
... After conducting a meta-analysis on this subject in 2017, Chun et al. [16] reported that an increased LSA is a known cause of LBP. However, this has been debated, and many systematic reviews and meta-analyses with conflicting conclusions stated that lumbar lordosis did not differ between subjects with and without LBP [12,[17][18][19][20][21]. It has been reported that confounding factors such as age, sex, and BMI influence the degree of lordosis [22][23][24]. ...
... LLA in both those with and without back pain was similar in all subgroups of age, BMI, and gender, showing no association with these confounding factors. Earlier reports have also stated no association of lordosis with back pain [12,[17][18]. Further, LSA and LLA were similar in patients having moderate and severe pain, showing no association with the severity of pain (p = 0.557 and p = 0.448, respectively). Data analysis in our study shows that both LSA and LLA show only a weak correlation with age, gender, BMI, and severity of pain in both groups. ...
Background: Low back pain (LBP) is a common health condition with an estimated prevalence of 42-83% in India. Clinicians usually measure lumbar lordotic angle (LLA) and lumbosacral angle (LSA) in sagittal radiographs even though the normal range of lordosis has not yet been agreed upon. Hence, the radiographic measurement of these angles needs to be re-evaluated. We aimed to study the difference in LLA and LSA in those with and without non-specific acute LBP and to analyze the correlation and association of confounding factors like age, gender, BMI, and pain severity with LLA and LSA.
Methods: LLA and LSA in those with and those without non-specific acute LBP in 200 individuals were recorded and analyzed statistically.
Results: In age, gender, and BMI-matched groups, the LSA in the cases group (34.44 ± 5.93) was significantly less than in controls (36.9 ± 6.8) (p = 0.007). LLA in the non-specific acute LBP group (50.51 ± 8.78) and those without non-specific acute LBP (50.05 ± 9.86) was statistically similar (p = 0.727). LSA was significantly less in patients than in healthy subjects. Both LLA and LSA were not associated withback pain and showed a weak or very weak correlation with age, gender, BMI, and severity of pain in both groups.
Conclusion: Lumbar lordosis didn’t show any association or correlation with age, gender, BMI, and VAS in non-specific acute LBP patients. Hence, measuring LSA and LLA in sagittal radiographs does not provide any additional information regarding the cause of pain in non-specific acute LBP patients.
