Restriction in Lateral Bending Range of Motion, Lumbar Lordosis, and Hamstring Flexibility Predicts the Development of Low Back Pain: A Systematic Review of Prospective Cohort Studies

Abstracts

The aim of this review was to investigate lower back and/or lower limb musculoskeletal risk factors in the development of low back pain (LBP).

Twelve articles which evaluated musculoskeletal risk factors in the development of low back pain in 5,459 participants were included.

Individual meta-analyses were conducted based on risk factors common between studies.

Meta-analyses investigating the following 12 musculoskeletal risk factors were conducted: lumbar extension range of motion (ROM), quadriceps flexibility, fingertip to floor distance, lumbar flexion ROM, lumbar lordosis, back muscle strength, back muscle endurance, abdominal strength, lateral bending ROM, erector spinae cross-sectional area (CSA), quadratus lumborum CSA, and hamstring flexibility.

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Based on the results of the meta-analyses, restrictions in lateral flexion ROM, hamstring flexibility and lumbar lordosis were found to increase the risk of participants developing LBP.

The findings of the review also suggest that a reduced lumbar lordosis is an important musculoskeletal risk factor for the development of LBP.

The authors noted that other sagittal plane parameters, such as sacral slope and pelvic incidence, can influence the degree of lordosis and these parameters themselves could be associated with the development of LBP.

Restricted hamstring ROM has been linked to reduced lumbar lordosis and it is perhaps through this mechanism and subsequent stiffness in the lower back that a significant association was demonstrated.

Advising patients of the relationship of these musculoskeletal measures to LBP plus the therapy options to modify these risk factors may potentially serve to prevent the development of LBP.

The risk factors that were found to be nonsignificant for the development of LBP require more investigation before they can be confidently recommended as risk factors that should be measured in clinical practice.

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References:

Sadler, S. G., Spink, M. J., Ho, A., Jonge, X. J. D., Chuter, V. H. (2017) Restriction in Lateral Bending Range of Motion, Lumbar Lordosis, and Hamstring Flexibility Predicts the Development of Low Back Pain: A Systematic Review of Prospective Cohort Studies. BMC Musculoskeletal Disorders: May 2017, Vol. 18, No. 179. doi: 10.1186/s12891-017-1534-0

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