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Sagittal lumbo-pelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises – a randomized controlled trial
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background Context

Assessment of posture and alignment is often a main focus in the classification and treatment for patients with low back pain. However, there is much not known regarding the effects of motor control interventions on objective measures of lumbo-pelvic alignment.

Purpose

The primary aim of this study was to describe the variation of sagittal lumbo-pelvic alignment in patients with nociceptive mechanical low back pain. The secondary aim was to compare the effects of low-load motor control exercises and a high-load lifting exercise on change in alignment with a special emphasis on patients with high and low degrees of lumbar lordosis and sacral angle.

Study Design

This study is a secondary analysis of a randomized controlled trial evaluating the effects of a high-load lifting exercise (HLL) and low-load motor control training (LMC).

Patient Sample

Patients from the primary study, i.e. patients with a dominating pattern of nociceptive mechanical low back pain, who agreed to participate in the radiographic examination were included (n=66).

Outcome measures

Lateral plain radiographic images were used to evaluate lumbo-pelvic alignment regarding lumbar lordosis and sacral angle as outcomes and posterior bend as an explanatory variable.

Methods

The participants were recruited from two occupational health care facilities. They were randomized to LMC or HLL intervention group and offered 12 sessions of exercise with an instructor. Outcome measures were collected at baseline at the end of intervention period 2 months after baseline.

Between and within group analyses of intervention groups and sub-groups based on the distribution of the baseline values for lumbar lordosis and sacral angle respectively, (LOW, MID, HIGH), were performed using both parametric and non-parametric tests.

This study was supported by two grants from Visare Norr and Norrbotten County Council.

Results

The lumbar lordosis and sacral angle in the present sample had a wide distribution, while the mean values for lumbar lordosis was 59.0, SD 11.5 degrees and for sacral angle 42.0, SD 9.6 degrees. There were no difference between groups in the percent change in either outcome measure. Neither did any outcome change significantly over time within the intervention groups. In the sub-groups based on the distribution of baseline values for lumbar lordosis and sacral angle respectively, the sub-group LOWlu representing low baseline values of lumbar lordosis increased their lumbar lordosis significantly. The sub-group HIGHsa, representing high baseline values for sacral angle, decreased their sacral angle significantly following intervention.

Conclusions

This study is the first to describe the wide distribution of values for lumbo-pelvic alignment for patients with nociceptive mechanical low back pain. There is however further need to investigate other types of low back pain in order to contrast these findings to other sub-groups of low back pain. The results also suggest that re-training of lumbo-pelvic alignment could be possible for patients with low back pain.

Keyword [en]
Low back pain, motor control, deadlift, alignment, lumbo-pelvic, lumbar lordosis, sacral angle, posterior bend
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-119934OAI: oai:DiVA.org:umu-119934DiVA: diva2:925688
Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2016-05-11
In thesis
1. Deadlift training for patients with mechanical low back pain: a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises
Open this publication in new window or tab >>Deadlift training for patients with mechanical low back pain: a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Disability due to low back pain is common. While evidence exist that exercise is effective in reducing pain and disability, it is still largely undetermined which kind of exercises that are most effective. The overall aim of this thesis was to evaluate and compare the effects of a high-load lifting exercise and individualized low-load motor control exercises for patients with nociceptive mechanical low back pain. A secondary aim was to evaluate which patients benefit from training with a high-load lifting exercise.

All four papers in this thesis were based on a randomized controlled trial including 70 participants with nociceptive mechanical low back pain as their dominating pain pattern. Participants were randomized into training with either a high-load lifting exercise (HLL), the deadlift, (n=35) or individualized low-load motor control exercises (LMC) (n=35). Both interventions included aspects of pain education. All participants were offered twelve sessions during an eight week period. The effects of the interventions were evaluated directly after and twelve months after the end of the intervention period. Outcome measures were pain intensity, activity, disability, physical performance, lumbo-pelvic alignment and lumbar multifidus muscle thickness.

There was a significant between-group effect in favour of the LMC intervention regarding improvements in activity, movement control tests and some tests of trunk muscle endurance. For pain intensity there were no significant differences between groups. A majority of participants in both intervention groups showed clinically meaningful improvements from baseline to two and twelve month follow-up regarding pain intensity and activity. There were no significant differences between HLL and LMC regarding the effect on lumbo-pelvic alignment or lumbar multifidus thickness. The participants who benefit the most from the HLL intervention were those with a low pain intensity and high performance in the Biering-Sørensen test at baseline.

The results of this thesis showed that the HLL intervention was not more effective than the LMC intervention. The LMC was in fact more effective in improving activity, performance in movement control tests and some tests of trunk muscle endurance, compared to the HLL intervention.

The results imply that the deadlift, when combined with education, could be considered as an exercise to produce clinically relevant improvements on pain intensity in patients who prefer a high-load exercise. However, before considering deadlift training, the results suggest that pain intensity and performance in the Biering-Sørensen test should be evaluated.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 66 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1806
Keyword
Low back pain, Motor control, Deadlift, Randomized controlled trial, Pain, Disability, Activity
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-119939 (URN)978-91-7601-481-3 (ISBN)
Public defence
2016-06-02, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-05-12 Created: 2016-05-03 Last updated: 2016-05-26Bibliographically approved

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