Does Movement Change When Low Back Pain Changes? A Systematic Review.

OBJECTIVE: To investigate the relationship between changes in volitional spinal movement (including muscle activity) and changes in pain or activity limitation at the individual level in people with nonspecific low back pain.

DESIGN: Etiology systematic review.

LITERATURE SEARCH: MEDLINE, Embase, CINAHL, and AMED were searched from inception to January 2020.

STUDY SELECTION CRITERIA: The study included peer-reviewed articles that reported the relationship between changes in volitional spinal movement and changes in pain or activity limitation at the individual level in people with nonspecific low back pain.

DATA SYNTHESIS: The data were descriptively synthesized to identify a relationship between change in movement and improved pain or activity limitation.

RESULTS: We included 27 studies involving 2739 participants. There was low-quality evidence of a relationship between change in movement and change in pain or activity limitation at the individual level 31% of the time (20 of the 65 times investigated within the 27 studies). Increases in spinal range of motion, velocity, and flexion relaxation of the back extensors were consistently related to improved pain or activity limitation (93%, 18.5/20 relationships observed).

CONCLUSION: A relationship between changes in movement and changes in pain or activity limitation was infrequently observed at the individual level; however, a paucity of high-quality evidence precludes a definitive understanding of this relationship. J Orthop Sports Phys Ther 2020;50(12):664-680. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9635 .