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Comparative Study
. 2007 Jan 29:8:8.
doi: 10.1186/1471-2474-8-8.

Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI

Kornelia Kulig  1 , Christopher M Powers, Robert F Landel, Hungwen Chen, Michael Fredericson, Marc Guillet, Kim Butts
Affiliations
Comparative Study

Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI

Kornelia Kulig et al. BMC Musculoskelet Disord. .

Abstract

Background: Altered spinal mobility is thought to be related to current or past episodes of low back pain; however evidence of that relationship in younger subjects has not been established. The purpose of this study was to compare lumbar segmental mobility in asymptomatic and symptomatic subjects during posterior to anterior (PA) manual spinal mobilization and a self-initiated prone press-up (PU) maneuver. We hypothesized that persons with central low back pain would have an altered lumbar segmental mobility pattern compared to those without pain.

Method: Forty-five individuals (age 32.1 +/- 8.5) with non-specific low back pain and 20 persons (age 31.1 +/- 7.0) without low back pain participated. Each subject underwent dynamic imaging of the lumbar spine during a PA mobilization procedure and while performing a PU. Segmental motion was quantified as the change in the intervertebral angle between the resting and end-range vertebral positions.

Results: The symptomatic group had a larger percentage of subjects with evidence of single level segmental hypermobility than the asymptomatic group during the PA (40.0% vs. 5%) and PU (26.7% vs. 15%) procedures. Single lumbar motion-segment analysis revealed hyper-mobility in symptomatic subjects at L5 - S1 (Chi-square = 10.0, p < or = 0.01) and L4 - L5 (Chi-square = 4.18, p < or = 0.05) during the PA test.

Conclusion: Persons with non-specific low back pain have a tendency to demonstrate single level lumbar segmental hypermobility when compared to age specific asymptomatic subjects.

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Figures

Figure 1
Figure 1
Subject and examiner positioned within the MRI system for (a) the segmental motion of the target lumbar segment during the posterior to anterior (PA) mobilization procedure and (b) the prone press-up PU maneuver. Each subject was situated such that the spine and torso were within the opening between the vertical magnets.
Figure 2
Figure 2
Measurements of intervertebral displacement resulting from the posterior to anterior (PA) mobilization and the prone press-up (PU) maneuver. The intervertebral (segmental) angle was measured as the angle formed by lines defining the endplates of adjacent vertebrae. Segmental lumbar displacement was defined as the difference in the intervertebral angle between the resting position (left) and intervertebral angle from the end range image (right). The arrow in Figure 2a identifies the hand of the examiner performing the PA mobilization.
Figure 3
Figure 3
Mean segmental motion of the target lumbar segment during the posterior to anterior (PA) mobilization procedure. Error bars represent 1 SD.
Figure 4
Figure 4
Mean segmental motion of the lumbar segments during the prone press-up (PU) maneuver. Error bars represent 1 SD.
See this image and copyright information in PMC

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