Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies

Abstract

BackgroundLow back pain (LBP) is an increasingly common condition worldwide with significant costs associated with its management. Identification of musculoskeletal risk factors that can be treated clinically before the development of LBP could reduce costs and improve the quality of life of individuals. Therefore the aim was to systematically review prospective cohort studies investigating lower back and / or lower limb musculoskeletal risk factors in the development of LBP.MethodsMEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus, and the Cochrane Library were searched from inception to February 2016. No age, gender or occupational restrictions of participants were applied. Articles had to be published in English and have a 12 month follow-up period. Musculoskeletal risk factors were defined as any osseous, ligamentous, or muscular structure that was quantifiably measured at baseline. Studies were excluded if participants were pregnant, diagnosed with cancer, or had previous low back surgery. Two authors independently reviewed and selected relevant articles. Methodological quality was evaluated independently by two reviewers using a generic tool for observational studies.ResultsTwelve articles which evaluated musculoskeletal risk factors for the development of low back pain in 5459 participants were included. Individual meta-analyses were conducted based on risk factors common between studies. Meta-analysis revealed that reduced lateral flexion range of motion (OR = 0.41, 95% CI 0.24-0.73, p = 0.002), limited lumbar lordosis (OR = 0.73, 95% CI 0.55-0.98, p = 0.034), and restricted hamstring range of motion (OR = 0.96, 95% CI 0.94-0.98, p = 0.001) were significantly associated with the development of low back pain. Meta-analyses on lumbar extension range of motion, quadriceps flexibility, fingertip to floor distance, lumbar flexion range of motion, back muscle strength, back muscle endurance, abdominal strength, erector spinae cross sectional area, and quadratus lumborum cross sectional area showed non-significant results.ConclusionIn summary, we found that a restriction in lateral flexion and hamstring range of motion as well as limited lumbar lordosis were associated with an increased risk of developing LBP. Future research should aim to measure additional lower limb musculoskeletal risk factors, have follow up periods of 6-12 months, adopt a standardised definition of LBP, and only include participants who have no history of LBP.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1534-0) contains supplementary material, which is available to authorized users.

Reliability of Hamstring Flexibility Test with Hip Inferior Glide Mobilization in Patients with Low Back Pain

“…The Kolmogorov-Smirnov test confirmed a normal data distribution. The intraclass correlation coefficient (ICC [3,1]) was used to measure intrarater testretest reliability. A correlation coefficient ≥0.75 was considered "good to excellent," 0.50-0.75 was considered "moderate to good," 0.25-0.50 was considered "fair," and 0.00-0.25 indicated "little or no relationship".…”

“…Low back pain (LBP) is a leading cause of disability worldwide and is associated with major economic costs. 1,2 Approximately 90% of adults will suffer from LBP during their lifetime. 3 Individuals with hamstring tightness are at an increased risk of developing LBP.…”

“…3 Individuals with hamstring tightness are at an increased risk of developing LBP. 1 Hamstring tightness promotes increased lumbar flexion during forward-bending tasks and reduces lumbar lordosis, which contributes to LBP. 3,4 To assess hamstring flexibility in LBP patients, the active knee extension (AKE) and straight leg raise test are commonly administered to subjects in the supine position.…”

Hip Abductor To Hip Adductor Strength Ratio Measurements In Patients With Non-Specific Low Back Pain

“…4,16,17,28 By decreasing lumbar lordosis to a significant amount, the lumbar spine begins to lose its lordotic curve. 56 This places more pressure on the vertebrae and alter normal postural alignment. 56 Having restricted range of motion of the hamstrings, subsequently increases stiffness of the low back.…”

“…56 This places more pressure on the vertebrae and alter normal postural alignment. 56 Having restricted range of motion of the hamstrings, subsequently increases stiffness of the low back. 56 Although many studies discuss how hamstring tightness will lead to LBP, there have been few studies that contradict this finding.…”