The Ratio of Lumbar to Hip Motion during the Trunk Flexion in Patients with Mechanical Chronic Low Back Pain According to O’Sullivan Classification System: A Cross-sectional Study

Document Type : RESEARCH PAPER

Authors

1 Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences

2 Department of Physiotherapy, school of Rehabilitation Sciences, Iran University of Medical Sciences.

3 Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran. Orthopedic research center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background: Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two important
aspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare the
posture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand health
subjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O’Sullivan’s
classification system (OCS).
Methods: This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low back
pain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3D
motion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to full
bend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion were
divided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using oneway
analysis of variance (ANOVA) and independent t-test.
Results: There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positions
between the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significant
difference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significant
difference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group,
and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there was
statistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026).
In this position, the difference in hip angles between the healthy group and FP group was statistically significant
(P<0.05). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBP
group (P=0.062), however, there was a significant difference between FP group and the healthy group in the fourth
Q of the total hip range of motion. There was no statistically significant difference between the healthy group and the
heterogeneous LBP group (P=0.054) but there was a difference between FP group and the healthy group. Lumbar/hip
motion ratio (L/H ratio) was different between and within the subgroups in the second Q.
Conclusion: This study supported the subgrouping of LBP and showed that the difference between subgroups could
be determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It is
possible that the neuromuscular system selects different strategies to compensate and prevent further injury of the
chain components (muscle, joint, nerve and etc.).
Level of evidence: IV

Keywords

Main Subjects

References

1. Dankaerts W, O’Sullivan P, Burnett A, Straker L.
Differences in sitting postures are associated with
nonspecific chronic low back pain disorders when
patients are subclassified. Spine (Phila Pa 1976).
2006; 31(6):698-704.
2. Dankaerts W, O’Sullivan P, Burnett A, Straker L, Davey
P, Gupta R. Discriminating healthy controls and two
clinical subgroups of nonspecific chronic low back
pain patients using trunk muscle activation and
lumbosacral kinematics of postures and movements:
a statistical classification model. Spine. 2009;
34(15):1610-8.
3. Vibe Fersum K, O’Sullivan P, Skouen JS, Smith A, Kvale
A. Efficacy of classification-based cognitive functional
therapy in patients with non-specific chronic low
back pain: a randomized controlled trial. Eur J Pain.
2013; 17(6):916-28.
4. Van Hoof W, Volkaerts K, O’Sullivan K, Verschueren
S, Dankaerts W. Comparing lower lumbar kinematics
in cyclists with low back pain (flexion pattern)
versus asymptomatic controls--field study using a
wireless posture monitoring system. Man Ther. 2012;
17(4):312-7.
5. Vibe Fersum K, O’Sullivan P, Skouen J, Smith A, Kvåle
A. Efficacy of classification‐based cognitive functional
therapy in patients with non‐specific chronic low
back pain: a randomized controlled trial. Eur J Pain.
2013; 17(6):916-28.
6. Colloca CJ, Hinrichs RN. The biomechanical and
clinical significance of the lumbar erector spinae
flexion-relaxation phenomenon: a review of literature.
J Manipulative Physiol Ther. 2005; 28(8):623-31.
7. Bratton RL. Assessment and management of
acute low back pain. Am Fam Physician. 1999;
60(8):2299-308.
8. Tafazzol A, Arjmand N, Shirazi-Adl A, Parnianpour
M. Lumbopelvic rhythm during forward and
backward sagittal trunk rotations: combined in
vivo measurement with inertial tracking device
and biomechanical modeling. Clin Biomech. 2014;
29(1):7-13.
9. O’Sullivan PB, Mitchell T, Bulich P, Waller R, Holte J.
The relationship beween posture and back muscle
endurance in industrial workers with flexion-related
low back pain. Man Ther. 2006; 11(4):264-71.
10. Ramalingam AT, Senthilkumar SN, Hanif SR,
Rameshbhai SK, Kasim SA. Movement control
impairment tests in patients with low back pain
and healthy controls and its correlation with clinical
measures. Physiotherapy. 2017; 11(2):58.
11. O’Sullivan P. Clinical instability’of the lumbar spine:
its pathological basis, diagnosis and conservative
management. Grieve’s Modern Manual Therapy: The
Vertebral Column. London: Churchill Livingstone;
2004.
12. O’Sullivan PB. Lumbar segmentalinstability: clinical
presentation and specific stabilizing exercise
management. Man Ther. 2000; 5(1):2-12.
13. Kim MH, Yi CH, Kwon OY, Cho SH, Cynn HS, Kim
YH, et al. Comparison of lumbopelvic rhythm and
flexion-relaxation response between 2 different low
back pain subtypes. Spine (Phila Pa 1976). 2013;
38(15):1260-7.
14. Hoffman SL, Johnson MB, Zou D, Van Dillen LR.
Differences in end-range lumbar flexion during
slumped sitting and forward bending between low
back pain subgroups and genders. Man Ther. 2012;
17(2):157-63.
15. Williams JM, Haq I, Lee RY. Dynamic lumbar
curvature measurement in acute and chronic low
back pain sufferers. Arch Phys Med Rehabil. 2012;
93(11):2094-9.
16. Qualisys A, Gothenburg S. Qualisys track manager.
New York: User Manual; 2011.
17. Kejonen P, Kauranen K. Reliability and validity of
standing balance measurements with a motion
analysis system. Physiotherapy. 2002; 88(1):25-32.
18. Laird RA, Kent P, Keating JL. How consistent are
lordosis, range of movement and lumbo-pelvic
rhythm in people with and without back pain? BMC
Musculoskelet Disord. 2016; 17(1):403.
19. Betsch M, Wehrle R, Dor L, Rapp W, Jungbluth P,
Hakimi M, et al. Spinal posture and pelvic position
during pregnancy: a prospective rasterstereographic
pilot study. Eur Spine J. 2015; 24(6):1282-8.
20. O’Sullivan PB. Lumbar segmental ‘instability’:
clinical presentation and specific stabilizing exercise
management. Man Ther. 2000; 5(1):2-12.
21. Astfalck RG, O’Sullivan PB, Smith AJ, Straker LM,
Burnett AF. Lumbar spine repositioning sense
in adolescents with and without non-specific
chronic low back pain--an analysis based on subclassification
and spinal regions. Man Ther. 2013;
18(5):410-7.
22. Sheeran L, Sparkes V, Caterson B, Busse-Morris M, van
Deursen R. Spinal position sense and trunk muscle
activity during sitting and standing in nonspecific
chronic low back pain: classification analysis. Spine
(Phila Pa 1976). 2012; 37(8):E486-95.
23. Dankaerts W, O’Sullivan P. The validity of O’Sullivan’s
classification system (CS) for a sub-group of NS-CLBP
with motor control impairment (MCI): overview of
a series of studies and review of the literature. Man
Ther. 2011; 16(1):9-14.
24. O’Sullivan P. Diagnosis and classification of chronic
low back pain disorders: maladaptive movement and
motor control impairments as underlying mechanism.
Man Ther. 2005; 10(4):242-55.
25. Sahrmann S. Diagnosis and treatment of movement
impairment syndromes. New York: Elsevier Health
Sciences; 2002.
26. Dankaerts W, O’Sullivan PB, Straker LM, Burnett
AF, Skouen JS. The inter-examiner reliability of a
classification method for non-specific chronic low
back pain patients with motor control impairment.
Man Ther. 2006; 11(1):28-39.
27. Panjabi MM. The stabilizing system of the spine. Part
II. Neutral zone and instability hypothesis. J Spinal
Disord. 1992; 5(4):390-6.
28. Panjabi MM. The stabilizing system of the spine. Part I.
Function, dysfunction, adaptation, and enhancement.
J Spinal Disord. 1992; 5(4):383-9.
29. Descarreaux M, Lafond D, Cantin V. Changes in the
flexion-relaxation response induced by hip extensor
and erector spinae muscle fatigue. BMC Musculoskelet
Disord. 2010; 11(1):112.
30. McClure PW, Esola M, Schreier R, Siegler S. Kinematic
analysis of lumbar and hip motion while rising from
a forward, flexed position in patients with and
without a history of low back pain. Spine. 1997;
22(5):552-8.
31. O’sullivan PB, Phyty GD, Twomey LT, Allison GT.
Evaluation of specific stabilizing exercise in the
treatment of chronic low back pain with radiologic
diagnosis of spondylolysis or spondylolisthesis. Spine.
1997; 22(24):2959-67.
32. Burnett AF, Cornelius MW, Dankaerts W, O’Sullivan
PB. Spinal kinematics and trunk muscle activity in
cyclists: a comparison between healthy controls and
non-specific chronic low back pain subjects-a pilot
investigation. Man Ther. 2004; 9(4):211-9.
33. O’Sullivan K, Verschueren S, Van Hoof W, Ertanir F,
Martens L, Dankaerts W. Lumbar repositioning error
in sitting: healthy controls versus people with sittingrelated
non-specific chronic low back pain (flexion
pattern). Man Ther. 2013; 18(6):526-32.
34. Holm S, Indahl A, Solomonow M. Sensorimotor
control of the spine. J Electromyogr Kinesiol. 2002;
12(3):219-34.
35. Wong TK, Lee RY. Effects of low back pain on the
relationship between the movements of the lumbar
spine and hip. Hum Mov Sci. 2004; 23(1):21-34.
36. Yeganeh A, Moghtadaei M, Motalebi M. A challenge on
orthopedic sciences: the influence of spinal disease
and deformities on total hip arthroplasty: a review on
literature. Arch Bone Jt Surg. 2018; 6(5):346-52.
The Archives of Bone and Joint Surgery
Volume 6, Issue 6
November 2018
Pages 560-569

Files

History

  • Receive Date: 11 April 2018
  • Revise Date: 09 June 2018
  • Accept Date: 21 June 2018

Share

How to cite

Statistics