Recurrent Low Back Pain:Linking Mechanisms to Outcomes

A growing body of evidence suggests that poor neuromuscular control of the lumbopelvic region
is an important finding in a large number of patients with recurrent and chronic low back
pain and may play a role in recurrence of symptoms. Despite findings of altered trunk motor
control in individuals with low back pain, the neuromuscular strategies underlying these
alterations have not been satisfactorily characterized. The aims of this study are to(1)
identify which neural control strategies are altered following a rehabilitation program that
emphasizes trunk control and stability using a motor learning approach and (2) provide
preliminary evidence of a link between hypothesized mechanism and effectiveness for programs
designed to improve trunk control.

Inclusion criteria for healthy controls:

No history of low back is defined as:

1. no pain limiting performance of daily activities for greater than 3 days,

2. no pain for which they sought medical or allied health intervention.

Inclusion Criteria for individuals with a history of low back pain:

1. duration of the current episode of low back pain less than 3 months,

2. average pain intensity over past 2 weeks at least 3 on an 11 point (0 = no pain, 10 =
worst pain ever) numeric pain rating scale,

3. no medical intervention for low back pain in last 6 months,

4. Oswestry disability score greater than 20%

5. a physical therapy diagnosis of clinical lumbar instability based upon specific
examination findings.

Exclusion Criteria for both groups:

1. permanent structural spinal deformity (e.g., scoliosis)

2. history of spinal fracture or diagnosis of osteoporosis

3. diagnosis of inflammatory joint disease

4. signs of systemic illness or suspected non-mechanical LBP (i.e. spinal tumor or
infection)

5. previous spinal surgery

6. frank neurological loss, i.e., weakness and sensory loss

7. history of neurologic disease that required hospitalization,

8. active treatment of another medical illness that would preclude participation in any
aspect of the study or any lower extremity injury that would potentially alter trunk
movement in standing

9. leg length discrepancy of greater than 2.5 cm.

10. pregnancy

11. vestibular dysfunction