Wednesday, August 5, 2009

Lumbo-coxa contribution to forward bending in symptomatic & asymptomatic LBA cases.

I. Asymmetry 3-dimensional motion patterns in Chr. LBA

Chronic LBP patients exhibited motion patterns altered from those of the normal population. 3D motion analyses reveal 3 distinct patterns of motion observed in each principal direction of movement in LBA cases. They are reflected as:

1. Differences in the extension-flexion ratio (asymmetry between flexion and extension).
2. Lateral bending asymmetry and
3. Differences in coupled axial rotation-lateral bending ratio.

II. Lumbar-hip flexion motion in LBA

A. Hip movements in normal healthy patients without LBA during forward bending of the lumbar spine:

1. Earlier reported values for lumbar spine motion during forward bending vary from 23.9 degrees to 60 degrees and hip motion during forward bending ranges from 26 degrees to 66 degrees.

2. Esola & colleagues found mean total forward bending to be 111 degrees: 41.6 degrees from the lumbar spine and 69.4 degrees from the hips.

B. The lumbo-coxa contribution to forward bending:


1. To describe the movement forward bending is divided into early (0-30 degrees), middle (30-60 degrees), and late (60-90 degrees). Esola & colleagues found, Lumbar-to-hip ratios for early, middle, and late forward bending were 1.9, 0.9, and 0.4, respectively.

2. Therefore, the lumbar spine had a greater contribution to early forward bending, the lumbar spine and hips contributed almost equally to middle forward bending, and the hips had a greater contribution to late forward bending.

3. Hamstring flexibility is strongly correlated to motion in subjects with a history of low back pain, but not in healthy subjects.

III. Chr. LBA cases with reduced hip movements:

The hips and lumbar spine both contribute to the forward bending motion, and an aberrant pattern of contribution in one or both regions could be related to the presence of chronic low back pain (2).

Porter & colleagues carried out a study 32 white men aged 18-36 years; 15 with chronic low back pain and 17 asymptomatic. The method used to study was a 3-dimensional motion analysis that allowed uninterrupted forward bending. The results of this study are as follows:

1. The men with chronic low back pain demonstrate a significant reduction in the mean total range and mean maximum lumbar flexion relative to the asymptomatic group.

2. Mean hip flexion was not significantly different.

3. Data analysis for 120 degrees of gross flexion revealed a subgroup of men with chronic low back pain with a significant decrease in hip flexion.

This study reveals 2 distinct subgroups of individuals with chr. LBA. One moved relatively similarly to the asymptomatic group, whereas the other sub-group demonstrated reduced hip mobility. Hence it is important to assess not only the lumbar spine motions but also hip flexion motion in chronic low back pain patients.

Esola & colleagues (3) reported that although people with a history of low back pain have amounts of lumbar spine and hip motion during forward bending similar to those of healthy subjects, the pattern of motion is different. It may be desirable to teach patients with a history of low back pain to use more hip motion during early forward bending, and hamstring stretching may be helpful for encouraging earlier hip motion.

Reference:

1. Lund T et al; Spine (Phila Pa 1976). 2002 Sep 1;27(17):1865-74.
2. Porter JL et al; Spine (Phila Pa 1976). 1997 Jul 1;22(13):1508-13; discussion 1513-4.
3. Esola MA et al; Spine (Phila Pa 1976). 1996 Jan 1;21(1):71-8.

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