THE ASSOCIATION OF LOW BACK PAIN WITH LUMBAR SPINE MOVEMENT CONTROL IMPAIRMENT SYNDROMES – A COHORT STUDY

P.R. Rytkönen^1,2, J. Takatalo^3,2, P. Oura^3,4, H. Luomajoki⁵, H. Ruotsalainen⁶, M. Tuiskunen⁶, J. Karppinen^3,4

¹Fysios Mehiläinen, Oulu, Finland, ²Loisto Terveys, Oulu, Finland, ³Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland, ⁴Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland, ⁵Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland, ⁶Oulu University of Applied Sciences, Oulu, Finland

Background: Movement control impairment (MCI) tests have a good reliability in chronic low back pain (LBP). Yet, the association of the LBP and lumbar spine MCI syndromes have not been studied in population-based cohort.

Purpose: The purpose of the study is to assess the association of LBP with lumbar spine MCI syndromes in large population-based study.

Methods: The study population included 1907 participant of the Northern Finland Birth Cohort 1966 (NFBC66). The participants were drawn from the whole NFBC66 population based on the willingness to participate the whole day physical assessment including the lumbar spine MCI tests at the age of 46 years in 2012. The study was a cross-sectional cohort study. Five MCI tests were chosen to this study: Sitting knee extension, prone knee bend, one leg stance, rocking backwards and waiters bow. Tests were categorized according to the direction of which MCI was tested with each test. The MCI tests were analyzed from the video recorded during the physical assessment. The frequency and level of disability of LBP was recorded and categorized into the three groups: low, medium, or high level of LBP. A multinomial regression analysis was used to analyze the association of LBP with each MCI directions were calculated and the model was adjusted for BMI, gender, socioeconomic status, mental health, physical activity and smoking.

Results: High level of LBP is associated with MCI when one flexion-rotation (sitting knee extension or one-leg-stance) test is positive on the left side (OR 2.36; 95% confidence interval 1.14-4.87). Moreover, high level of LBP is associated with flexion-rotation test on the left side when both tests are positive (OR 2.45; 1.10-5.54). In the crude regression analyses the high level of LBP is associated with flexion-rotation test on both sides when one test is positive (OR 1.88; 1.04-3.39), however, the association attenuated in the adjusted model (OR 2.06; 0.96-4.44). The medium LBP is associated with MCI when both flexion-rotation tests (sitting knee extension and one-leg-stance) on the left side are positive (OR 2.51; 1.17-5.39). In the adjusted model of analyses high level of LBP is associated with combined both side rotation test when three tests are positive (OR 3.02; 1.01-9,03). The medium LBP is associated with rotation MCI on the left side when two and three tests are positive (OR 2.67; 1.04-6.87 and OR 3.37; 1.21-9.39, respectively).

Conclusions: The high level of LBP is associated with MCI flexion-rotation test on the left side when at least one test is positive and MCI rotation test on both sides when three tests are positive. The medium level of LBP is associated with MCI flexion-rotation test on the left side when two tests are positive and MCI rotation test on the left side when at least two tests are positive.

Implications: The flexion-rotation and rotation MCI tests can be used in the clinic to evaluate the patients with LBP especially when the pain level is moderate to high.

Funding acknowledgements: We would like to acknowledge Finnish Association of Orthopedic Manual Therapy and Finnish Association of Physiotherapists for providing funding.

Keywords:
Low back pain
Movement control impairment
Lumbar spine

Topics:
Musculoskeletal: spine
Pain & pain management
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Oulu University Hospital

Committee: Ethical committee of Northern Ostrobothnia hospital district

Ethics number: -