Does movement matter in people with back pain? Investigating 'atypical' lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors

Abstract

Background: Interventions for low back pain (LBP) commonly target 'dysfunctional' or atypical lumbo-pelvic kinematics in the belief that correcting aberrant movement improves patients' pain and activity outcomes. If atypical kinematic parameters and postures have a relationship to LBP, they could be expected to more prevalent in people with LBP compared to people without LBP (NoLBP). This exploratory study measured, defined and compared atypical kinematic parameters in people with and without LBP.

Methods: Wireless inertial motion and EMG sensors were used to measure lumbo-pelvic kinematics during standing trunk flexion (range of motion (ROM), timing, sequence coordination, and extensor muscle activation) and in sitting (relative sitting position, pelvic tilt range) in a sample of 126 of adults without LBP and 140 chronic LBP subjects. Atypical movement was defined using the 10th/90th centiles of the NoLBP group. Mean differences and prevalence rates for atypical movement were calculated. Dichotomised pain scores for 'high-pain-on-bending' and 'high-pain-on-sitting' were tested for their association with atypical kinematic variables.

Results: For standing flexion, significant mean differences, after adjusting for age and gender factors, were seen for the LBP group with (i) reduced ROM (trunk flexion (NoLBP 111^o, LBP 93^o, p < .0001), lumbar flexion (NoLBP 52^o, LBP 46^o, p < .0001), pelvic flexion (NoLBP 59^o, LBP 48^o, p < .0001), (ii) greater extensor muscle activation for the LBP group (NoLBP 0.012, LBP 0.25 p < .0001), (iii) a greater delay in pelvic motion at the onset of flexion (NoLBP - 0.21 s; LBP - 0.36 s, p = 0.023), (iv) and longer movement duration for the LBP group (NoLBP 2.28 s; LBP 3.18 s, p < .0001). Atypical movement was significantly more prevalent in the LBP group for small trunk (× 5.4), lumbar (× 3.0) and pelvic ROM (× 3.9), low FRR (× 4.9), delayed pelvic motion at 20^o flexion (× 2.9), and longer movement duration (× 4.7). No differences between groups were seen for any sitting parameters. High pain intensity was significantly associated with small lumbar ROM and pelvic ROM.

Conclusion: Significant movement differences during flexion were seen in people with LBP, with a higher prevalence of small ROM, slower movement, delayed pelvic movement and greater lumbar extensor muscle activation but without differences for any sitting parameter.

Keywords: Assessment; Flexion relaxation; Low back pain; Lumbo-pelvic rhythm; Movement disorders; Range of movement (ROM); Velocity.

Fig. 1

Device Placement. An example of sensor placement with the lower border of the upper sensor placed at the T12 level, the upper border of the lower sensor level with S1 and the EMG sensors placed over lumbar extensor muscles at the level of L3

Fig. 2

Flexion relaxation ratio definition and calculation. The flexion relaxation ratio is calculated by dividing EMG activity while the subject is fully flexed for 3 s (numerator) by the sum of EMG activity in the eccentric plus concentric phases of flexion (denominator)

Fig. 3

Delay (lag) of pelvic compared to lumbar movement. These graphs show ROM (Y axis) changes over time (X axis). Graph a was from a subject who moved their lumbar spine into flexion with a two second delay before the pelvis started moving. Graph b shows a more typical pattern with a synchronous start of movement of the lumbar spine and pelvis