Spinal movement variability associated with low back pain: A scoping review

Hiroki Saito, Yoshiteru Watanabe, Toshiki Kutsuna, Toshihiro Futohashi, Yasuaki Kusumoto, Hiroki Chiba, Masayoshi Kubo, Hiroshi Takasaki, Hiroki Saito, Yoshiteru Watanabe, Toshiki Kutsuna, Toshihiro Futohashi, Yasuaki Kusumoto, Hiroki Chiba, Masayoshi Kubo, Hiroshi Takasaki

Abstract

Objective: To identify suggestions for future research on spinal movement variability (SMV) in individuals with low back pain (LBP) by investigating (1) the methodologies and statistical tools used to assess SMV; (2) characteristics that influence the direction of change in SMV; (3) the methodological quality and potential biases in the published studies; and (4) strategies for optimizing SMV in LBP patients.

Methods: We searched literature databases (CENTRAL, Medline, PubMed, Embase, and CINAHL) and comprehensively reviewed the relevant papers up to 5 May 2020. Eligibility criteria included studies investigating SMV in LBP subjects by measuring trunk angle using motion capture devices during voluntary repeated trunk movements in any plane. The Newcastle-Ottawa risk of bias tool was used for data quality assessment. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

Results: Eighteen studies were included: 14 cross-sectional and 4 prospective studies. Seven linear and non-linear statistical tools were used. Common movement tasks included trunk forward bending and backward return, and object lifting. Study results on SMV changes associated with LBP were inconsistent. Two of the three interventional studies reported changes in SMV, one of which was a randomized controlled trial (RCT) involving neuromuscular exercise interventions. Many studies did not account for the potential risk of selection bias in the LBP population.

Conclusion: Designers of future studies should recognize that each of the two types of statistical tools assesses functionally different aspects of SMV. Future studies should also consider dividing participants into subgroups according to LBP characteristics, as three potential subgroups with different SMV characteristics were proposed in our study. Different task demands also produced different effects. We found preliminary evidence in a RCT that neuromuscular exercises could modify SMV, suggesting a rationale for well-designed RCTs involving neuromuscular exercise interventions in future studies.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart of study selection process.
Fig 1. Flowchart of study selection process.
Fig 2. The frequency in the type…
Fig 2. The frequency in the type of spinal movement variability (SMV) across the studies.

References

    1. Kongsted A, Kent P, Axen I, Downie AS, Dunn KM. What have we learned from ten years of trajectory research in low back pain? BMC Musculoskelet Disord. 2016;17: 220. 10.1186/s12891-016-1071-2
    1. Dieën J, Reeves NP, Kawchuk G. Analysis of motor control in low-back pain patients: a key to personalized care? J Orthop Sport Phys Ther. 2018; 1–24. 10.2519/jospt.2019.7916
    1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al.. What low back pain is and why we need to pay attention. Lancet. 2018;391: 2356–2367. 10.1016/S0140-6736(18)30480-X
    1. Stergiou N, Decker LM. Human movement variability, nonlinear dynamics, and pathology: Is there a connection? Hum Mov Sci. 2011;30: 869–888. 10.1016/j.humov.2011.06.002
    1. Van Dieën JH, Flor H, Hodges PW. Low-Back Pain Patients Learn to Adapt Motor Behavior With Adverse Secondary Consequences. Exerc Sport Sci Rev. 2017;45: 223–229. 10.1249/JES.0000000000000121
    1. Bauer CM, Rast FM, Ernst MJ, Meichtry A, Kool J, Rissanen SM, et al.. The effect of muscle fatigue and low back pain on lumbar movement variability and complexity. J Electromyogr Kinesiol. 2017;33: 94–102. 10.1016/j.jelekin.2017.02.003
    1. Graham RB, Brown SHM. A direct comparison of spine rotational stiffness and dynamic spine stability during repetitive lifting tasks. J Biomech. 2012;45: 1593–1600. 10.1016/j.jbiomech.2012.04.007
    1. Mokhtarinia HR, Sanjari MA, Chehrehrazi M, Kahrizi S, Parnianpour M. Trunk coordination in healthy and chronic nonspecific low back pain subjects during repetitive flexion—extension tasks: Effects of movement asymmetry, velocity and load. Human Movement Science. 2016. pp. 182–192. 10.1016/j.humov.2015.11.007
    1. Hodges PW. Pain and motor control: From the laboratory to rehabilitation. J Electromyogr Kinesiol. 2011;21: 220–228. 10.1016/j.jelekin.2011.01.002
    1. Hamill J, Palmer C, Van Emmerik REA. Coordinative variability and overuse injury. Sport Med Arthrosc Rehabil Ther Technol. 2012;4: 45. 10.1186/1758-2555-4-45
    1. Van Dieën JH, Kingma I. Spine function and low back pain: interactions of active and passive structures. Spinal control: the rehabilitation of back pain: state of the art and science. Elsevier Ltd; 2013. pp. 41–57.
    1. Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15: 668–676. 10.1007/s00586-005-0925-3
    1. Cusumano JP, Cesari P. Body-goal variability mapping in an aiming task. Biol Cybern. 2006;94: 367–379. 10.1007/s00422-006-0052-1
    1. Graham RB, Sadler EM, Stevenson JM. Local dynamic stability of trunk movements during the repetitive lifting of loads. Hum Mov Sci. 2012;31: 592–603. 10.1016/j.humov.2011.06.009
    1. Harbourne RT, Stergiou N. Movement variability and the use of nonlinear tools: principles to guide physical therapist practice. Phys Ther. 2009;89: 267–282. 10.2522/ptj.20080130
    1. Asgari M, Sanjari MA, Mokhtarinia HR, Moeini Sedeh S, Khalaf K, Parnianpour M. The effects of movement speed on kinematic variability and dynamic stability of the trunk in healthy individuals and low back pain patients. Clin Biomech. 2015;30: 682–688. 10.1016/j.clinbiomech.2015.05.005
    1. Chehrehrazi M, Sanjari MA, Mokhtarinia HR, Jamshidi AA, Maroufi N, Parnianpour M. Goal equivalent manifold analysis of task performance in non-specific LBP and healthy subjects during repetitive trunk movement: Effect of load, velocity, symmetry. Hum Mov Sci. 2017;51: 72–81. 10.1016/j.humov.2016.11.005
    1. 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: 370–376. 10.1016/j.gaitpost.2008.10.053
    1. Dideriksen JL, Gizzi L, Petzke F, Falla D. Deterministic accessory spinal movement in functional tasks characterizes individuals with low back pain. Clin Neurophysiol. 2014;125: 1663–1668. 10.1016/j.clinph.2013.11.037
    1. van Dieën JH, Peter Reeves N, Kawchuk G, van Dillen LR, Hodges PW. Motor Control Changes in Low Back Pain: Divergence in Presentations and Mechanisms. Journal of Orthopaedic and Sports Physical Therapy. 2019. pp. 370–379. 10.2519/jospt.2019.7917
    1. Williams JM, Haq I, Lee RY. An experimental study investigating the effect of pain relief from oral analgesia on lumbar range of motion, velocity, acceleration and movement irregularity. BMC Musculoskelet Disord. 2014;15: 304. 10.1186/1471-2474-15-304
    1. Bauer CM, Kankaanpää MJ, Meichtry A, Rissanen SM, Suni JH. Efficacy of six months neuromuscular exercise on lumbar movement variability—A randomized controlled trial. J Electromyogr Kinesiol. 2019;48: 84–93. 10.1016/j.jelekin.2019.06.008
    1. Arampatzis A, Schroll A, Catalá MM, Laube G, Schüler S, Dreinhofer K. A random-perturbation therapy in chronic non-specific low-back pain patients: a randomised controlled trial. Eur J Appl Physiol. 2017;117: 2547–2560. 10.1007/s00421-017-3742-6
    1. Huijbregts PA. A new model for orthopaedic manual therapy research: Description and implications. J Man Manip Ther. 2007;15: 197–199. 10.1179/106698107790819431
    1. Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al.. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67: 1291–1294. 10.1016/j.jclinepi.2014.03.013
    1. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8: 19–32.
    1. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5: 69. 10.1186/1748-5908-5-69
    1. Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Heal. 2015;13: 141–146. 10.1097/XEB.0000000000000050
    1. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al.. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169: 467–473. 10.7326/M18-0850
    1. Duffy S, de Kock S, Misso K, Noake C, Ross J, Stirk L. Supplementary searches of {PubMed} to improve currency of MEDLINE and MEDLINE In-Process searches via Ovid. J Med Libr Assoc. 2016;104: 309–312. 10.3163/1536-5050.104.4.011
    1. Koch C, Hänsel F. Chronic Non-specific Low Back Pain and Motor Control During Gait. Front Psychol. 2018;9: 2236. 10.3389/fpsyg.2018.02236
    1. Laird RA, Gilbert J, Kent P, Keating JL. Comparing lumbo-pelvic kinematics in people with and without back pain: A systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15: 229. 10.1186/1471-2474-15-229
    1. Saraceni N, Kent P, Ng L, Campbell A, Straker L, O’Sullivan P. To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. J Orthop Sport Phys Ther. 2020;50: 121–130. 10.2519/jospt.2020.9218
    1. Swain CTV, Pan F, Owen PJ, Schmidt H, Belavy DL. No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. J Biomech. 2020;102: 109312. 10.1016/j.jbiomech.2019.08.006
    1. Rausch Osthoff A-K, Ernst MJ, Rast FM, Mauz D, Graf ES, Kool J, et al.. Measuring lumbar reposition accuracy in patients with unspecific low back pain: systematic review and meta-analysis. Spine (Phila Pa 1976). 2015;40: E97—E111. 10.1097/BRS.0000000000000677
    1. Gartlehner G, Affengruber L, Titscher V, Noel-Storr A, Dooley G, Ballarini N, et al.. Single-reviewer abstract screening missed 13 percent of relevant studies: a crowd-based, randomized controlled trial. J Clin Epidemiol. 2020;121: 20–28. 10.1016/j.jclinepi.2020.01.005
    1. Polanin JR, Pigott TD, Espelage DL, Grotpeter JK. Best practice guidelines for abstract screening large‐evidence systematic reviews and meta‐analyses. Res Synth Methods. 2019;10: 330–342.
    1. Duffett M, Choong K, Hartling L, Menon K, Thabane L, Cook DJ. Randomized controlled trials in pediatric critical care: a scoping review. Crit Care. 2013;17: R256. 10.1186/cc13083
    1. Farrah K, Young K, Tunis MC, Zhao L. Risk of bias tools in systematic reviews of health interventions: an analysis of PROSPERO-registered protocols. Syst Rev. 2019;8: 280. 10.1186/s13643-019-1172-8
    1. Elyasi M, Abreu LG, Badri P, Saltaji H, Flores-Mir C, Amin M. Impact of Sense of Coherence on oral health behaviors: A systematic review. PLoS One. 2015;10. 10.1371/journal.pone.0133918
    1. Heneghan NR, Smith R, Tyros I, Falla D, Rushton A. Thoracic dysfunction in whiplash associated disorders: A systematic review. PLoS One. 2018;13. 10.1371/journal.pone.0194235
    1. Wells GA, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al.. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute. Link . 2012.
    1. Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World Journal of Meta-Analysis. 2017. p. 80.
    1. Altman DG. Practical Statistics for Medical Research, London, Chapman and Hall. CRC; 1990.
    1. Osman A, Barrios FX, Kopper BA, Hauptmann W, Jones J, O’Neill E. Factor structure, reliability, and validity of the pain catastrophizing scale. J Behav Med. 1997;20: 589–605. 10.1023/a:1025570508954
    1. Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 363–372. 10.1016/0304-3959(94)00279-N
    1. Stergiou N, Harbourne R, Cavanaugh J. Optimal movement variability: a new theoretical perspective for neurologic physical therapy. J Neurol Phys Ther. 2006;30: 120–129. 10.1097/01.npt.0000281949.48193.d9
    1. Asgari N, Sanjari MA, Esteki A. Local dynamic stability of the spine and its coordinated lower joints during repetitive Lifting: Effects of fatigue and chronic low back pain. Hum Mov Sci. 2017;54: 339–346. 10.1016/j.humov.2017.06.007
    1. Graham RB, Oikawa LY, Ross GB. Comparing the local dynamic stability of trunk movements between varsity athletes with and without non-specific low back pain. J Biomech. 2014;47: 1459–1464. 10.1016/j.jbiomech.2014.01.033
    1. Ippersiel P, Robbins S, Preuss R. Movement variability in adults with low back pain during sit-to-stand-to-sit. Clin Biomech. 2018;58: 90–95. 10.1016/j.clinbiomech.2018.07.011
    1. Moreno Catalá M, Schroll A, Laube G, Arampatzis A. Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population. Front Neurosci. 2018;12: 436. 10.3389/fnins.2018.00436
    1. Pranata A, Perraton L, El-Ansary D, Clark R, Mentiplay B, Fortin K, et al.. Trunk and lower limb coordination during lifting in people with and without chronic low back pain. J Biomech. 2018;71: 257–263. 10.1016/j.jbiomech.2018.02.016
    1. Shojaei I, Vazirian M, Salt EG, Van Dillen LR, Bazrgari B. Timing and magnitude of lumbar spine contribution to trunk forward bending and backward return in patients with acute low back pain. J Biomech. 2017;53: 71–77. 10.1016/j.jbiomech.2016.12.039
    1. Williams JM, Haq I, Lee RY. A novel approach to the clinical evaluation of differential kinematics of the lumbar spine. Man Ther. 2013;18: 130–135. 10.1016/j.math.2012.08.003
    1. Shojaei I, Salt EG, Bazrgari B. A prospective study of lumbo-pelvic coordination in patients with non-chronic low back pain. J Biomech. 2019; 109306. 10.1016/j.jbiomech.2019.07.050
    1. Bauer CM, Rast FM, Ernst MJ, Oetiker S, Meichtry A, Kool J, et al.. Pain intensity attenuates movement control of the lumbar spine in low back pain. J Electromyogr Kinesiol. 2015;25: 919–927. 10.1016/j.jelekin.2015.10.004
    1. Jaeger P, Baggesgaard J, Sorensen JK, Ilfeld BM, Gottschau B, Graungaard B, et al.. Adductor canal block with continuous infusion versus intermittent boluses and morphine consumption: a randomized, double-blinded, controlled clinical trial. Lippincott Williams and Wilkins; 2017.
    1. Yang C, Leitkam S, Côté JN. Effects of different fatigue locations on upper body kinematics and inter-joint coordination in a repetitive pointing task. PLoS One. 2019;14: e0227247. 10.1371/journal.pone.0227247
    1. Heiderscheit BC, Hamill J, van Emmerik REA. Variability of Stride Characteristics and Joint Coordination among Individuals with Unilateral Patellofemoral Pain. J Appl Biomech. 2002;18: 110–121.
    1. Srinivasan D, Tengman E, Häger CK. Increased movement variability in one-leg hops about 20 years after treatment of anterior cruciate ligament injury. Clin Biomech. 2018;53: 37–45.
    1. Takabayashi T, Edama M, Inai T, Kubo M. Sex-related differences in coordination and variability among foot joints during running. J Foot Ankle Res. 2018;11: 53. 10.1186/s13047-018-0295-9
    1. Baida SR, Gore SJ, Franklyn-Miller AD, Moran KA. Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review. Scand J Med Sci Sport. 2018;28: 1320–1338. 10.1111/sms.13036
    1. Granata KP, Gottipati P. Fatigue influences the dynamic stability of the torso. Ergonomics. 2008;51: 1258–1271. 10.1080/00140130802030722
    1. Heneweer H, Staes F, Aufdemkampe G, van Rijn M, Vanhees L. Physical activity and low back pain: a systematic review of recent literature. Eur Spine J. 2011;20: 826–845. 10.1007/s00586-010-1680-7
    1. Devillé WL, Buntinx F, Bouter LM, Montori VM, de Vet HCW, van der Windt DAWM, et al.. Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol. 2002;2: 9. 10.1186/1471-2288-2-9
    1. van Dieën JH, Kingma I, van der Bug P. Evidence for a role of antagonistic cocontraction in controlling trunk stiffness during lifting. J Biomech. 2003;36: 1829–1836. 10.1016/s0021-9290(03)00227-6
    1. Bazrgari B, Shirazi-Adl A, Kasra M. Computation of trunk muscle forces, spinal loads and stability in whole-body vibration. J Sound Vib. 2008;318: 1334–1347.
    1. Marras WS, Davis KG, Ferguson SA, Lucas BR, Gupta P. Spine loading characteristics of patients with low back pain compared with asymptomatic individuals. Spine (Phila Pa 1976). 2001;26: 2566–2574. 10.1097/00007632-200112010-00009
    1. Metwali M. Motor variability, task performance, and muscle fatigue during training of a repetitive lifting task: adapting motor learning topics to occupational ergonomics research. University of Iowa. 2019.
    1. Forestier N, Nougier V. The effects of muscular fatigue on the coordination of a multijoint movement in human. Neurosci Lett. 1998;252: 187–190. 10.1016/s0304-3940(98)00584-9
    1. Huffenus A-F, Amarantini D, Forestier N. Effects of distal and proximal arm muscles fatigue on multi-joint movement organization. Exp Brain Res. 2006;170: 438–447. 10.1007/s00221-005-0227-3
    1. Fuller JR, Fung J, Côté JN. Time-dependent adaptations to posture and movement characteristics during the development of repetitive reaching induced fatigue. Exp Brain Res. 2011;211: 133–143. 10.1007/s00221-011-2661-8
    1. Jordan K, Challis JH, Newell KM. Walking speed influences on gait cycle variability. Gait Posture. 2007;26: 128–134. 10.1016/j.gaitpost.2006.08.010
    1. Millington PJ, Myklebust BM, Shambes GM. Biomechanical analysis of the sit-to-stand motion in elderly persons. Arch Phys Med Rehabil. 1992;73: 609–617.
    1. Reeves NP, Narendra KS, Cholewicki J. Spine stability: lessons from balancing a stick. Clin Biomech. 2011;26: 325–330.
    1. Laird RA, Keating JL, Kent P. Subgroups of lumbo-pelvic flexion kinematics are present in people with and without persistent low back pain. BMC Musculoskelet Disord. 2018;19: 309. 10.1186/s12891-018-2233-1
    1. Suni JH, Rinne M, Kankaanpää M, Taulaniemi A, Lusa S, Lindholm H, et al.. Neuromuscular exercise and back counselling for female nursing personnel with recurrent non-specific low back pain: study protocol of a randomised controlled trial (NURSE-RCT). BMJ Open Sport Exerc Med. 2016;2: e000098. 10.1136/bmjsem-2015-000098
    1. Papi E, Bull AMJ, McGregor AH. Spinal segments do not move together predictably during daily activities. Gait Posture. 2019;67: 277–283. 10.1016/j.gaitpost.2018.10.031

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe