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.
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.
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).
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).
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.
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.
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.
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.
Low back pain, motor control, deadlift, alignment, lumbo-pelvic, lumbar lordosis, sacral angle, posterior bend