Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI

Kornelia Kulig¹ , Christopher M Powers¹ , Robert F Landel¹ , Hungwen Chen¹ , Michael Fredericson² , Marc Guillet² and Kim Butts³

¹Department of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar St., CHP-155, Los Angeles, CA 90089, USA

²Department of Functional Restoration, Division of Sports Medicine, Stanford University, Stanford, CA 94305, USA

³Department of Radiology, Stanford University, Stanford, CA 94305, USA

author email corresponding author email

BMC Musculoskeletal Disorders 2007, 8:8doi:10.1186/1471-2474-8-8


Published:	29 January 2007

Abstract

Background

Altered spinal mobility is thought to be related to current or past episodes of low back pain; however evidence of that relationship in younger subjects has not been established. The purpose of this study was to compare lumbar segmental mobility in asymptomatic and symptomatic subjects during posterior to anterior (PA) manual spinal mobilization and a self-initiated prone press-up (PU) maneuver. We hypothesized that persons with central low back pain would have an altered lumbar segmental mobility pattern compared to those without pain.

Method

Forty-five individuals (age 32.1 ± 8.5) with non-specific low back pain and 20 persons (age 31.1 ± 7.0) without low back pain participated. Each subject underwent dynamic imaging of the lumbar spine during a PA mobilization procedure and while performing a PU. Segmental motion was quantified as the change in the intervertebral angle between the resting and end-range vertebral positions.

Results

The symptomatic group had a larger percentage of subjects with evidence of single level segmental hypermobility than the asymptomatic group during the PA (40.0% vs. 5%) and PU (26.7% vs. 15%) procedures. Single lumbar motion-segment analysis revealed hyper-mobility in symptomatic subjects at L5 – S1 (Chi-square = 10.0, p ≤ 0.01) and L4 – L5 (Chi-square = 4.18, p ≤ 0.05) during the PA test.

Conclusion

Persons with non-specific low back pain have a tendency to demonstrate single level lumbar segmental hypermobility when compared to age specific asymptomatic subjects.