Examination of the Lumbar Movement Pattern during a Clinical Test and a Functional Activity Test in People with and without Low Back Pain

Abstract

Background It is assumed that the lumbar movement pattern observed during a clinical test is representative of the movement pattern used during a functional activity. Very little is known about how the lumbar movement pattern during a clinical test is associated with the lumbar movement pattern during a functional activity and how the lumbar movement pattern is associated with functional limitation. Objective The purpose was to examine the lumbar movement pattern during a clinical test and a functional activity test in people with and people without low back pain (LBP), and the relationship of lumbar motion to LBP‐related functional limitation. Design Observational study. Participants 16 back‐healthy adults and 32 people with chronic LBP. Methods Participants performed a standardized clinical test of forward bending and a functional activity test of picking up an object. Main Outcome Measurements Maximal lumbar excursion and lumbar excursion at 0% to 50% and 50% to 100% of movement time were examined. Results Significant associations were present between the two movement tests for both back‐healthy people and people with LBP (r = 0.47‐0.73). In people with LBP the amount of lumbar motion in the 0% to 50% of movement time interval for both tests was significantly associated with functional limitation (r = 0.43‐0.62). Conclusion Lumbar movement patterns were similar between the two tests, and lumbar motion early in the movement of a functional test was related to self‐report of functional limitation. Level of Evidence III

Consistency of a lumbar movement pattern across functional activities in people with low back pain

“…Our findings are consistent with a previous study that found a significant, moderate-size association between mODI and early phase lumbar excursion in the reaching movement during the PUO test. (Marich et al, 2015) Thus, the current findings suggest that the manner in which a person moves the lumbar spine during a functional activity may contribute to the functional limitations. These findings are important because functional limitations are often the reason people with LBP seek treatment.…”

“…ASIS height was measured as the vertical distance from the floor to the ASIS. Participants performed five separate conditions of the functional activity test of Pick Up an Object (PUO)(Marich et al, 2015) presented in random order (Figure 1). The standard PUO test condition involved placing a 20 x 36 x 12 cm, lightweight, container on a surface so that the top of the container was at a height equal to the participant’s shank length and a distance equal to 50% of the participant’s trunk length (Standard).…”

“…(Marich et al, 2015) A total of 48 participants was determined to be sufficient to detect an interaction effect of group and test condition with a two-tailed α ≤ .05 and power of 0.80.…”

“…Recent data indicates that the lumbar movement pattern observed during the forward trunk flexion phase of the clinical test of forward bending is similar to the lumbar movement pattern used during the reaching phase of the functional activity test of picking up an object (PUO). (Marich et al, 2015) In the PUO test, people with LBP and high levels of functional limitation displayed greater lumbar excursion in the early phase of movement during the reaching phase compared to BH people and people with low levels of functional limitations. In addition, the amount of lumbar excursion in the early phase was associated with functional limitations.…”

“…In prior research, aspects of the lumbar movement pattern have been indexed using several different variables, including the onset and timing of movement of the lumbar spine relative to other joints,(Scholtes et al, 2009; Scholtes et al, 2010; Van Dillen et al, 2007) and the amount of lumbar excursion in a specific movement direction (Hoffman et al, 2012; Marich et al, 2015; Scholtes et al, 2009; Scholtes et al, 2010) during standardized clinical tests such as forward bending in standing. (Esola et al, 1996; McGregor et al, 1997) Differences have been reported between subgroups of people with LBP (Gombatto et al, 2007; Van Dillen et al, 2007) as well as between back-healthy (BH) people and people with LBP.…”