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Abady Avman M1, Snodgrass S1, Osmotherly P1, Rivett D1
1University of Newcastle, Faculty of Health, School of Health Sciences, Newcastle, Australia
Background: Nonspecific low back pain (NSLBP) is a common musculoskeletal problem affecting approximately 80% of the population during their lifetime. Altered hip kinematics, specifically limited hip movement, has been proposed to be associated with the presence of NSLBP in both athletic and non-athletic populations. If such an association can be demonstrated, physical examination of hip movement and subsequent treatment to improve any limitation found, may be relevant in the management of NSLBP patients.
Purpose: To systematically review the literature to determine whether there is an association between hip range of motion (ROM) and nonspecific low back pain (NSLBP).
Methods: MEDLINE, EMBASE, Cochrane library, PsychINFO, CINAHL and AMED databases were searched from year of inception until October 31st, 2018 , using a combination of LBP and hip joint search terms. Commonly cited journals were also hand searched within the previous two years. Two reviewers independently screened identified articles, initially by title and abstract and then by full text. After first round screening of 2908 identified records, 248 progressed to full text screening. Due to the heterogeneity of studies identified, post hoc inclusion criteria of English language, studies comparing subjects with LBP and healthy controls, cross-sectional design, and clinical measures of hip ROM were applied.Twenty-four records were finally included in the review. Extracted data included population characteristics, duration and severity of LBP, hip movement direction and testing position, measurement tool and between-group differences. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess for study bias.
Results: Hip flexion ROM was measured in seven studies, extension in 13 studies, internal rotation (IR) in 14 studies, external rotation (ER) in 13 studies, abduction in six studies, and adduction in only two studies. Among all the movements tested, IR was reported in more studies as being significantly reduced in participants with NSLBP compared to healthy individuals. Overall the quality of evidence was very low. Common sources of study bias included absent sample size justification, non-blinding of outcome assessors, lack of adjustment for key confounders, and poor reporting of measurement methods and between-group differences.
Conclusion(s): There is very low-quality evidence to support an association between limited hip ROM and NSLBP. Limited hip IR ROM was the only movement impairment found to be significantly associated with NSLBP, however this should be viewed with caution due to the low-quality supportive evidence. Further studies are needed.
Implications: Hip joint IR ROM assessment could be considered in the physical examination of patients presenting with NSLBP. Hip extension assessment should differentiate between joint ROM and hip flexor muscle length testing.
Keywords: low back pain, hip joint kinematic, range of motion
Funding acknowledgements: University funding provided for statistical assistance
Purpose: To systematically review the literature to determine whether there is an association between hip range of motion (ROM) and nonspecific low back pain (NSLBP).
Methods: MEDLINE, EMBASE, Cochrane library, PsychINFO, CINAHL and AMED databases were searched from year of inception until October 31st, 2018 , using a combination of LBP and hip joint search terms. Commonly cited journals were also hand searched within the previous two years. Two reviewers independently screened identified articles, initially by title and abstract and then by full text. After first round screening of 2908 identified records, 248 progressed to full text screening. Due to the heterogeneity of studies identified, post hoc inclusion criteria of English language, studies comparing subjects with LBP and healthy controls, cross-sectional design, and clinical measures of hip ROM were applied.Twenty-four records were finally included in the review. Extracted data included population characteristics, duration and severity of LBP, hip movement direction and testing position, measurement tool and between-group differences. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess for study bias.
Results: Hip flexion ROM was measured in seven studies, extension in 13 studies, internal rotation (IR) in 14 studies, external rotation (ER) in 13 studies, abduction in six studies, and adduction in only two studies. Among all the movements tested, IR was reported in more studies as being significantly reduced in participants with NSLBP compared to healthy individuals. Overall the quality of evidence was very low. Common sources of study bias included absent sample size justification, non-blinding of outcome assessors, lack of adjustment for key confounders, and poor reporting of measurement methods and between-group differences.
Conclusion(s): There is very low-quality evidence to support an association between limited hip ROM and NSLBP. Limited hip IR ROM was the only movement impairment found to be significantly associated with NSLBP, however this should be viewed with caution due to the low-quality supportive evidence. Further studies are needed.
Implications: Hip joint IR ROM assessment could be considered in the physical examination of patients presenting with NSLBP. Hip extension assessment should differentiate between joint ROM and hip flexor muscle length testing.
Keywords: low back pain, hip joint kinematic, range of motion
Funding acknowledgements: University funding provided for statistical assistance
Topic: Musculoskeletal: spine
Ethics approval required: No
Institution: University of Newcastle, Australia
Ethics committee: not applicable
Reason not required: this was a systematic review of the literature
All authors, affiliations and abstracts have been published as submitted.
