Date of Award
Doctor of Philosophy (PhD)
Low back pain (LBP) is a highly prevalent condition that is often characterized by persistent pain and limitations in the performance of daily functional activities. The repeated use of altered movement patterns during the performance of daily functional activities is proposed to contribute to the development and course of LBP. Specifically, in the case of LBP, the proposed alteration of movement is one in which the lumbar spine moves more readily than other joints that can contribute to the movement. This altered movement pattern is proposed to contribute to accumulation of localized tissue stress, micro- and macro-trauma of lumbar spine tissues and LBP symptoms. The purpose of this dissertation is to examine the lumbar movement pattern used during performance of functional activities in people with and people without LBP. In Chapter 2 we compared the lumbar movement pattern used during a standardized clinical test to the lumbar movement pattern used during the performance of a functional activity test in both back-healthy people and people with LBP. We found that the lumbar movement pattern used during the clinical test was significantly associated with the lumbar movement pattern used during the functional activity test. We also found that people with LBP and high levels of functional limitation demonstrated an altered lumbar movement pattern of greater lumbar excursion in the early phase of the test movement compared to BH people and people with LBP and low levels of functional limitation. Finally, we found that the amount of early-phase lumbar excursion was significantly associated with a person’s functional limitation. In Chapter 3 we examined the consistency of the lumbar movement pattern when aspects of the functional activity test were varied. We found that compared to back-healthy people and people with LBP and low levels of functional limitation, people with LBP and high levels of functional limitation consistently displayed an altered lumbar movement pattern of greater early-phase lumbar excursion across test conditions. In addition, we found that the amount of early-phase lumbar excursion was significantly associated with a person’s functional limitation. In Chapter 4, we examined the ability of people with LBP to modify their preferred lumbar movement pattern during a functional activity test, within a single session of motor skills training (MST). We also examined the effect of modifying the lumbar movement pattern on a person’s LBP symptoms, and the characteristics of people with LBP that influenced their ability to modify the lumbar movement pattern. We found that prior to training people with LBP displayed an altered movement pattern of greater early-phase lumbar excursion compared to back-healthy people. Following MST, we found that people with LBP were able to reduce significantly the amount of early-phase lumbar excursion during the performance of the functional activity. We also found that a significant number of participants with LBP reported decreased LBP symptoms during the functional activity following the MST. Additionally, we found that the amount of early-phase lumbar excursion in the preferred movement, and the duration of LBP were significant predictors of a person’s ability to modify the preferred lumbar movement pattern following MST. The results of this dissertation provide initial evidence (1) supporting the proposal that people with LBP adopt altered lumbar movement patterns during performance of functional activities, (2) that a person’s lumbar movement pattern is associated with functional limitation, (3) that people with LBP can modify the altered lumbar movement pattern, and (4) that modifying the lumbar movement pattern has an immediate effect of reducing symptoms during performance of a functional activity. Additional research is needed to examine whether the modified lumbar movement pattern is (1) retained, (2) transferred to additional functional activities, and (3) has an effect on a person’s functional limitation.
Chair and Committee
Linda R. Van Dillen
Catherine E. Lang, Michael J. Mueller, Shirley A. Sahrmann, Gretchen B. Salsich,
Marich, Andrej Vincent, "Examining the Lumbar Movement Pattern During Functional Activities in People With Low Back Pain" (2017). Arts & Sciences Electronic Theses and Dissertations. 1130.