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Review
. 2014 Jul 10;15:229.
doi: 10.1186/1471-2474-15-229.

Comparing Lumbo-Pelvic Kinematics in People With and Without Back Pain: A Systematic Review and Meta-Analysis

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Free PMC article
Review

Comparing Lumbo-Pelvic Kinematics in People With and Without Back Pain: A Systematic Review and Meta-Analysis

Robert A Laird et al. BMC Musculoskelet Disord. .
Free PMC article

Abstract

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 studies that compared biomechanical aspects of lumbo-pelvic movement in people with and without LBP.

Methods: MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2014 for relevant studies. Studies had to compare adults with and without LBP using skin surface measurement techniques to measure lumbo-pelvic posture or movement. Two reviewers independently applied inclusion and exclusion criteria, and identified and extracted data. Standardised mean differences and 95% confidence intervals were estimated for group differences between people with and without LBP, and where possible, meta-analyses were performed. Within-group variability in all measurements was also compared.

Results: The search identified 43 eligible studies. Compared to people without LBP, on average, people with LBP display: (i) no difference in lordosis angle (8 studies), (ii) reduced lumbar ROM (19 studies), (iii) no difference in lumbar relative to hip contribution to end-range flexion (4 studies), (iv) no difference in standing pelvic tilt angle (3 studies), (v) slower movement (8 studies), and (vi) reduced proprioception (17 studies). Movement variability appeared greater for people with LBP for flexion, lateral flexion and rotation ROM, and movement speed, but not for other movement characteristics. Considerable heterogeneity exists between studies, including a lack of detail or standardization between studies on the criteria used to define participants as people with LBP (cases) or without LBP (controls).

Conclusions: On average, people with LBP have reduced lumbar ROM and proprioception, and move more slowly compared to people without LBP. Whether these deficits exist prior to LBP onset is unknown.

Figures

Figure 1
Figure 1
Flow diagram of study inclusion.
Figure 2
Figure 2
Studies comparing lordosis in LBP versus NoLBP groups. Means & standard deviations (SD) are in degrees with the exception of Day et al. [32] who used an algebraic computation based on linear measurement.
Figure 3
Figure 3
Flexion ROM meta-analysis.
Figure 4
Figure 4
Extension ROM meta-analysis.
Figure 5
Figure 5
Lateral flexion ROM meta-analysis.
Figure 6
Figure 6
Rotation ROM meta-analysis.
Figure 7
Figure 7
Meta-analysis of studies investigating the relative contributions of lumbar versus hip ROM through the range of trunk flexion. Means (and SDs) are ratios of lumbar to hip movement. Zero represents equal lumbar to hip contribution to trunk flexion, numbers <0 indicate less lumbar compared with hip movement while numbers >0 indicate more hip than lumbar movement.
Figure 8
Figure 8
Meta-analysis of studies comparing pelvic tilt angle in neutral standing.
Figure 9
Figure 9
Forest plot of speed differences between LBP and NoLBP groups (original units are deg/sec or deg/sec 2 ).
Figure 10
Figure 10
Forest plot of position/reposition differences (raw scores in degrees) comparing LBP and NoLBP groups.

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