Modifying patterns of movement in people with low back pain -does it help? A systematic review

BMC Musculoskeletal Disorders

Jennifer L Keating²  Peter Kent¹  Robert A Laird³ 

[1] Research Department, Spine Centre of Southern Denmark, Lillibaelt Hospital, Institute of Regional Health Services Research, University of Southern Denmark, Middelfart, Denmark;Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria, 3199, Australia;Postal Address: 7 Kerry Rd, Warranwood, Melbourne, Victoria, 3134, Australia

关键词: Posture;    Exercise therapy;    Randomized controlled trial;    Movement disorders;    Low back pain;   

Others  :  1145861
DOI  :  10.1186/1471-2474-13-169

 received in 2012-04-16, accepted in 2012-08-21,  发布年份 2012

【 摘 要 】

Background

Physiotherapy for people with low back pain frequently includes assessment and modification of lumbo-pelvic movement. Interventions commonly aim to restore normal movement and thereby reduce pain and improve activity limitation. The objective of this systematic review was to investigate: (i) the effect of movement-based interventions on movement patterns (muscle activation, lumbo-pelvic kinematics or postural patterns) of people with low back pain (LBP), and (ii) the relationship between changes in movement patterns and subsequent changes in pain and activity limitation.

Methods

MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2012. Randomised controlled trials or controlled clinical trials of people with LBP were eligible for inclusion. The intervention must have been designed to influence (i) muscle activity patterns, (ii) lumbo-pelvic kinematic patterns or (iii) postural patterns, and included measurement of such deficits before and after treatment, to allow determination of the success of the intervention on the lumbo-pelvic movement. Twelve trials (25% of retrieved studies) met the inclusion criteria. Two reviewers independently identified, assessed and extracted data. The PEDro scale was used to assess method quality. Intervention effects were described using standardised differences between group means and 95% confidence intervals.

Results

The included trials showed inconsistent, mostly small to moderate intervention effects on targeted movement patterns. There was considerable heterogeneity in trial design, intervention type and outcome measures. A relationship between changes to movement patterns and improvements in pain or activity limitation was observed in one of six studies on muscle activation patterns, one of four studies that examined the flexion relaxation response pattern and in two of three studies that assessed lumbo-pelvic kinematics or postural characteristics.

Conclusions

Movement-based interventions were infrequently effective for changing observable movement patterns. A relationship between changes in movement patterns and improvement in pain or activity limitation was also infrequently observed. No independent studies confirm any observed relationships. Challenges for future research include defining best methods for measuring (i) movement aberrations, (ii) improvements in movements, and (iii) the relationship between changes in how people move and associated changes in other health indicators such as activity limitation.

【 授权许可】

   
2012 Laird et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

【 参考文献 】

• [1]Weiner BK: The biopsychosocial model and spine care. Spine 2008, 33(2):219-223.
• [2]Waddell G: Low Back Pain: A Twentieth Century Health Care Enigma. Spine 1996, 21(24):2820-2825.
• [3]Kent P, Keating JL: Classification in non-specific low back pain - what methods do primary care clinicians currently use? Spine 2005, 30:1434-1440.
• [4]Koes B, van Tulder M, Thomas S: Diagnosis and treatment of low back pain. Br Med J 2006, 332:1430-1434.
• [5]Battié MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L: The Twin Spine Study: Contributions to a changing view of disc degeneration. Spine J 2009, 9(1):47-59.
• [6]Smith A, O'Sullivan P, Straker L: Classification of sagittal thoraco-lumbo-pelvic alignment of the adolescent spine in standing and its relationship to low back pain. Spine 2008, 33(19):2101-2107.
• [7]Scannell J, McGill S: Lumbar posture-should it, and can it, be modified? A study of passive tissue stiffness and lumbar position during activities of daily living. Phys Ther 2003, 83(10):907-917.
• [8]Teyhen DS, Flynn TW, Childs JD, Abraham LD: Arthrokinematics in a subgroup of patients likely to benefit from a lumbar stabilization exercise program. Phys Ther 2007, 87(3):313-325.
• [9]Hodges P, van den Hoorn W, Dawson A, Cholewicki J: Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. J Biomech 2009, 42(1):61-66.
• [10]Hodges P, Richardson C: Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominus. Spine 1996, 21(22):2640-2650.
• [11]Lee J, Hoshino Y, Nakamura K, Ooi Y: Trunk muscle imbalance as a risk factor of the incidence of low back pain: a 5-year propsective [sic] study. J Neuomusculoskeletal Syst 1999, 7(3):97-101.
• [12]Hides JA, Richardson CA, Jull GA: Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 1996, 21(23):2763-2769.
• [13]Van Daele U, Hagman F, Truijen S, Vorlat P, Van Gheluwe B, Vaes P: Decrease in postural sway and trunk stiffness during cognitive dual-task in nonspecific chronic low back pain patients, performance compared to healthy control subjects. Spine 2010, 35(5):583-589.
• [14]Descarreaux M, Blouin J-S, Teasdale N: Repositioning accuracy and movement parameters in low back pain subjects and healthy control subjects. Eur Spine J 2005, 14(2):185-191.
• [15]Silfies SP, Mehta R, Smith SS, Karduna AR: Differences in Feedforward Trunk Muscle Activity in Subgroups of Patients With Mechanical Low Back Pain. Arch Phys Med Rehabil 2009, 90(7):1159-1169.
• [16]Wallwork TL, Stanton WR, Freke M, Hides JA: The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther 2009, 14(5):496-500.
• [17]Hides J, Gilmore C, Stanton W, Bohlscheid E: Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008, 13(1):43-49.
• [18]Hides JA, Jull GA, Richardson CA: Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 2001, 26(11):E243-248.
• [19]Dunk NM, Callaghan JP: Lumbar spine movement patterns during prolonged sitting differentiate low back pain developers from matched asymptomatic controls. Work 2010, 35(1):3-14.
• [20]Williams MM, Hawley JA, McKenzie RA, van Wijmen PM: A comparison of the effects of two sitting postures on back and referred pain. Spine 1991, 16(10):1185-1191.
• [21]Gregory DE, Callaghan JP, Gregory DE, Callaghan JP: Prolonged standing as a precursor for the development of low back discomfort: an investigation of possible mechanisms. Gait Posture 2008, 28(1):86-92.
• [22]Esola MA, McClure PW, Fitzgerald GK, Siegler S: Analysis of lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain. Spine 1996, 21(1):71-78.
• [23]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):552-558.
• [24]Silfies SP, Bhattacharya A, Biely S, Smith SS, Giszter S: Trunk control during standing reach: A dynamical system analysis of movement strategies in patients with mechanical low back pain. Gait Posture 2009, 29(3):370-376.
• [25]Shum GL, Crosbie J, Lee RYW: Three-Dimensional Kinetics of the Lumbar Spine and Hips in Low Back Pain Patients During Sit-to-Stand and Stand-to-Sit. Spine 2007, 32(7):E211-E219.
• [26]Richardson C, Jull G, Hodges P, Hides J: Therapeutic exercise for spinal segmental stabilization in low back pain : scientific basis and clinical approach. Churchill Livingstone, Edinburgh; 1999.
• [27]Bryan M, Hawson S: The Benefits of Pilates Exercise in Orthopaedic Rehabilitation. Tech Orthop March 2003, 18(1):126-129.
• [28]McKenzie R, May S: Lumbar Spine, Mechanical Diagnosis and Therapy. 2nd edition. Spinal Publications Ltd, Waikanae, New Zealand; 2003.
• [29]Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom N: The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. Arch Phys Med Rehabil 2003, 84(3):313-322.
• [30]Slade SC, Keating JL: Trunk-strengthening exercises for chronic low back pain: a systematic review. J Manipulative Physiol Ther 2006, 29(2):163-173.
• [31]Slade SC, Keating JL: Unloaded movement facilitation exercise compared to no exercise or alternative therapy on outcomes for people with nonspecific chronic low back pain: a systematic review. J Manipulative Physiol Ther 2007, 30(4):301-311.
• [32]van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW: Exercise therapy for chronic nonspecific low-back pain. Best Pract Clin Rheumatol 2010, 24(2):193-204.
• [33]Ernst E, Canter PH: The Alexander technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd 2003, 10(6):325-329.
• [34]Little P, Lewith G, Webley F, Evans M, Beattie A, Middleton K, Barnett J, Ballard K, Oxford F, Smith P, et al.: Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.[see comment]. BMJ 2008, 337:a884.
• [35]Lim ECW, Poh RLC, Low AY, Wong WP: Effects of Pilates-Based Exercises on Pain and Disability in Individuals With Persistent Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2011, 41(2):70-80.
• [36]Ferreira P, Ferreira M, Maher C, Herbert R, Refshauge K: Specific stabilisation exercise for spinal and pelvic pain: A systematic review. J Physiother 2006, 52:79-88.
• [37]Hauggaard A, Persson AL: Specific spinal stabilisation exercises in patients with low back pain – a systematic review. Phys Ther Rev 2007, 12(3):233-248.
• [38]Macedo LG, Maher CG, Latimer J, McAuley JH: Motor Control Exercise for Persistent, Nonspecific Low Back Pain: A Systematic Review. Phys Ther 2009, 89(1):9-25.
• [39]May S, Johnson R: Stabilisation exercises for low back pain: a systematic review. Physiotherapy 2008, 94(3):179-189.
• [40]Rackwitz B, DeBie R, Ewert T, Stucki G: Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin Rehabil 2006, 20:553-567.
• [41]Ferreira PH, Ferreira ML, Hodges PW: Changes in recruitment of the abdominal muscles in people with low back pain ultrasound measurement of muscle activity. Spine 2004, 29(2):2560-2566.
• [42]Verhagen AP, de Vet HCW, de Bie RA, Kessels AGH, Boers M, Bouter LM, Knipschild PG: The Delphi List: A Criteria List for Quality Assessment of Randomized Clinical Trials for Conducting Systematic Reviews Developed by Delphi Consensus. J Clin Epidemiol 1998, 51(12):1235-1241.
• [43]Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins A: Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003, 83:713-721.
• [44]de Morton N: The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. J Physiother 2009, 55(2):192-133.
• [45]da Fonseca JL, Magini M, de Freitas TH: Laboratory gait analysis in patients with low back pain before and after a pilates intervention. J Sport Rehabil 2009, 18(2):269-282.
• [46]Unsgaard-Tondel M, Fladmark AM, Salveson O, Vasseljen O: Motor control exercises, sling exercises and general exercises for patients with CLBP: a RCT with 1 year follow-up. Phys Ther 2010, 90(10):1-14.
• [47]Vasseljen O, Fladmark AM: Abdominal muscle contraction thickness and function after specific and general exercises: A randomized controlled trial in chronic low back pain patients. Man Ther 2010, 15(5):482-489.
• [48]Review Manager (RevMan) 50th edition. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen; 2008.
• [49]Akbari A, Khorashadizadeh S, Abdi G: The effect of motor control exercise versus general exercise on lumbar local stabilizing muscles thickness: randomized controlled trial of patients with chronic low back pain. J Back Musculoskel Rehabil 2008, 21(2):105-112.
• [50]Haugstad GK, Haugstad TS, Kirste UM, Leganger S, Wojniusz S, Klemmetsen I, Malt UF: Continuing improvement of chronic pelvic pain in women after short-term Mensendieck somatocognitive therapy: results of a 1-year follow-up study. Am J Obstet Gynecol 2008, 199(6):e611-e618.
• [51]Lalanne K, Lafond D, Descarreaux M: Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group study. J Manipulative Physiol Ther 2009, 32(3):203-209.
• [52]Magnusson ML, Chow DH, Diamandopoulos Z, Pope MH: Motor control learning in chronic low back pain. Spine 2008, 33(16):E532-538.
• [53]Mannion AF, Muntener M, Taimela S, Dvorak J: 1999 Volvo Award Winner in Clinical Studies: a randomized clinical trial of three active therapies for chronic low back pain. Spine 1999, 24(23):2435-2448.
• [54]Mannion AF, Taimela S, Muntener M, Dvorak J: Active therapy for chronic low back pain part 1. Effects on back muscle activation, fatigability, and strength. Spine 2001, 26(8):897-908.
• [55]Marshall P, Murphy B: Muscle activation changes after exercise rehabilitation for chronic low back pain. Arch Phys Med Rehabil 2008, 89(7):1305-1313.
• [56]O'Sullivan P, Twomey L, Allison G: Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention. J Orthop Sports Phys Ther 1998, 27(2):114-124.
• [57]O'Sullivan P, 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):2959-2967.
• [58]Ritvanen T, Zaproudina N, Nissen M, Leinonen V, HÃnninen O: Dynamic Surface Electromyographic Responses in Chronic Low Back Pain Treated by Traditional Bone Setting and Conventional Physical Therapy. J Manipulative Physiol Ther 2007, 30(1):31-37.
• [59]Freeman MD, Woodham MA, Woodham AW: The role of the lumbar multifidus in chronic low back pain: a review. Pm & R 2010, 2(2)):142-146. quiz 141 p following 167
• [60]Vasseljen O, Unsgaard-Tondel M, Westad C, Mork P: Effect of Core Stability Exercises on Feedforward Activation of Deep Abdominal Muscles in Chronic Low Back Pain: A Randomized Controlled Trial. Spine 2012.
• [61]Ferreira P, Ferreira M, Maher C, Refshauge K, Herbert R, Hodges P: Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. Br J Sports Med 2010, 44:1166-1172.
• [62]Neblett R, Mayer TG, Gatchel RJ, Keeley J, Proctor T, Anagnostis C: Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications. Spine 2003, 28(13):1435-1446.
• [63]Geisser ME, Ranavaya M, Haig AJ, Roth RS, Zucker R, Ambroz C, Caruso M: A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. J Pain 2005, 6(11):711-726.
• [64]Watson P, Booker C, Main C, Chen A: Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio. Clin Biomech 1997, 12:165-171.
• [65]de Fonseca JL, Magini M, de Freitas TH: Laboratory gait analysis in patients with low back pain before and after a Pilates intervention. J Sport Rehabil 2009, 18(2):269-282.
• [66]Haugstad GK, Haugstad TS, Kirste UM, Leganger S, Klemmetsen I, Malt UF: Mensendieck somatocognitive therapy as treatment approach to chronic pelvic pain: results of a randomized controlled intervention study. Am J Obstet Gynecol 2006, 194(5):1303-1310.
• [67]Morris SL, Lay B, Allison GT: Corset hypothesis rebutted — Transversus abdominis does not co-contract in unison prior to rapid arm movements. Clin Biomech 2012, 27:249-254.
• [68]Mannion AF, Junge A, Taimela S, Muntener M, Lorenzo K, Dvorak J: Active therapy for chronic low back pain: part 3. Factors influencing self-rated disability and its change following therapy. Spine 2001, 26(8)):920-929.
• [69]Dankaerts W, O'Sullivan P, Burnett A, Straker L, 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 2006, 31(6):698-704.
• [70]Dankaerts W, O'Sullivan P, Burnett A, Straker L, Dankaerts W, O'Sullivan P, Burnett A, Straker L: Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification. Spine 2006, 31(17):2017-2023.
• [71]Koppenhaver SL, Hebert JJ, Parent EC, Fritz JM: Rehabilitative ultrasound imaging is a valid measure of trunk muscle size and activation during most isometric sub-maximal contractions: a systematic review. J Physiother 2009, 55(3):153-169.
• [72]Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, Maher CG, Refshauge KM: Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial. Pain 2007, 131(1–2):31-37.
• [73]Neblett R, Mayer TG, Brede E, Gatchel RJ: Correcting abnormal flexion-relaxation in chronic lumbar pain: responsiveness to a new biofeedback training protocol. Clin J Pain 2010, 26(5):403-409.
• [74]Soukup MG, Glomsrod B, Lonn JH, Bo K, Larsen S: The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up. Spine 1999, 24(15):1585-1591. discussion 1592