Reliability of three landmarking methods for dual inclinometry measurements of lumbar flexion and extension

The Immediate Effects of Dry Cupping the Lumbar Paraspinals on Range of Motion and Temperature

Dry cupping is a therapeutic modality proposed to produce a negative pressure, stretching the skin and underlying tissue. This mechanism is said to promote regional blood flow of oxygenated blood and causing a physiological stretch in the tissue, allowing it to elongate and potentially changing skin temperature. The possible effects of the application to the lumbar spine paraspinal muscles, however, has not been thoroughly examined. The purpose of this pilot study was to explore the immediate effects of dry cupping the lumbar paraspinals on lumbar spine range of motion (ROM) and overlying skin temperature. 30 healthy individuals aged 18-30 years completed the study. The dry cupping was placed on the lumbar paraspinal muscles for 10-minutes. Two plastic cups were placed on the bilateral paraspinals muscles at L1 and L5. Lumbar spine flexion ROM and skin temperature were measured pre- and post-intervention. Descriptive statistics and paired sample t-tests were used to analyze the data (p < .05). There was a statistically significant increase in lumbar spine flexion ROM measured with the Sit and Reach Test, t(29) = 12.62 p = 0.001; d = 2.34, and inclinometry, t(29) = 11.10, p = 0.001; d = 3.86, with a large effect size. There was also a statistically significant decrease in the skin temperature of the lumbar spine paraspinals, t(29) = -2.23, p = 0.034; d = 0.75, with a medium effect size, post-intervention. Dry cupping may be an effective strategy to increase lumbar spine ROM and decrease stiffness, promote recovery, and reduce functional limitations. Future research may examine the difference in effectiveness of static compared to dynamic cupping in a symptomatic population.

Reliability and Validity of the Double Inclinometer Method for Assessing Thoracolumbar Joint Position Sense and Range of Movement in Patients with a Recent History of Low Back Pain

The study was aimed at examining the reliability of the Double Inclinometer (DI) method for the assessment of thoracolumbar Range of Movement (ROM) and Joint Position Sense (JPS) in patients with a recent history of Low Back Pain (LBP). Twenty patients with a history of LBP in the last three months participated. The thoracolumbar ROM and JPS were examined from a standing position by using both the DI and the tape measure method. The DI method was found to have moderate to good intra-rater (ICC = 0.68-0.79, SEM = 2.20-2.77°, SDD = 6.09-7.67°), moderate inter-rater (ICC = 0.59-0.62, SEM = 2.96-3.35°, SDD = 8.19-9.27°) and poor test-retest reliability (ICC = 0.13-0.17, SEM = 3.98-4.32°, SDD = 11.02-11.96°) for the assessment of thoracolumbar JPS. For the assessment of thoracolumbar ROM, the DI method was found to have good to excellent intra-rater (ICC = 0.88-0.94, SEM = 4.25-6.20°, SDD = 11.77-17.17°), excellent inter-rater (ICC = 0.90-0.91, SEM = 7.26-7.74°, SDD = 20.11-21.43°) and excellent test-retest reliability (ICC = 0.91-0.93, SEM = 6.03-6.87°, SDD = 16.70-19.02°). The concurrent validity of the DI method with the tape measure method was found to be very weak for the assessment of thoracolumbar JPS (r = 0.02, p = 0.93) and strong for the assessment of thoracolumbar ROM (r = 0.66, p = 0.001). The DI method seems to be a very reliable method for the assessment of thoracolumbar ROM in individuals with a recent history of LBP.

Comparison of the efficacy of acupuncture at the TUNG’s extra points and the traditional Chinese medicine points for elderly patients with chronic low back pain in Thailand

Objective

To compare the efficacy of acupuncture at TUNG’s extra points and traditional Chinese medicine (TCM) points for elderly patients with chronic low back pain (CLBP) in Thailand.

Methods

A single-blinded, randomized controlled trial with 84 elderly volunteers with CLBP was designed. The patients were randomly assigned either to the group getting acupuncture at TUNG’s extra points or to the group getting acupuncture at TCM points. The treatment period was 30 min per session for seven consecutive days. Before and after treatment, the score of the numeric rating scale (NRS), the back range of motion (BROM), and the back strength were measured and compared.

Results

After treatment, both groups were found with decreased NRS scores and increased BROM (P<0.05), but with no statistical difference in their back strength in comparison with that before treatment in the same group (P>0.05). Regarding the between-group comparison, no significant differences were found in the NRS score or BROM in the direction of forward flexion and right lateral flexion or the back strength after treatment (P>0.05). However, statistical differences were found in the BROM in directions of back extension (P<0.01) and left lateral flexion (P<0.05).

Conclusion

Acupuncture at TUNG’s extra points can decrease the low back pain NRS score and increase the back strength and the BROM in directions of forward flexion and right lateral flexion, equivalent to acupuncture at TCM points. Acupuncture at TCM points has a better effect in increasing the BROM in directions of back extension and left lateral flexion; acupuncture at TUNG’s extra points is suitable for elderly CLBP patients, and it should be supported and promoted.

The relationship between handgrip and rotator cuff muscle strength in shoulder pain: a cross-sectional study

Background/Aims

Shoulder pain is reported to be the third most common musculoskeletal disorder. Rotator cuff muscles play an important role in stabilising the shoulder and decreasing pain. Assessment of handgrip strength has been proposed as an indicator of rotator cuff function in healthy individuals, but not in those experiencing shoulder pain. The aim of this study was to assess the relationship between handgrip strength and shoulder rotator cuff strength in patients experiencing shoulder pain as a result of pathology or surgical intervention. A secondary aim was to identify any association between the duration of shoulder pain and handgrip strength and shoulder rotator cuff strength.

Methods

A total of 32 patients with shoulder pain (19 men, 13 women) were evaluated. The mean age was 52.88 (± 15.66) years, with a mean duration of shoulder pain of 13.44 (± 10.22) weeks. Handgrip strength was measured using the standard Jamar hydraulic hand dynamometer, and individual isometric rotator cuff strength was measured using the Baseline push-pull dynamometer.

Results

Correlation was found between handgrip strength and the abductor (r=0.58), external rotator (r=0.57), and internal rotator strength (r=0.59). A linear regression model was used to derive the equations for the association. No significant (P>0.05) correlation was found between the duration of pain and the handgrip strength or rotator cuff strength.

Conclusions

The strength of the correlation found indicates that handgrip strength can be used for assessment and within a rehabilitation programme to monitor rotator cuff function in patients with shoulder pain or post-surgical rehabilitation. The strength of rotator cuff muscles can be predicted by the equations derived from the regression model relating to grip strength assessment.

The short-term effects of instrument-based mobilization compared with manual mobilization for low back pain: A randomized clinical trial

BACKGROUND

Despite being used as a manipulation technique, no studies have examined the effectiveness of physiotherapy instrument mobilization (PIM) as a mobilization technique on pain and functional status in patients with low back pain (LBP).

OBJECTIVE

To investigate the effectiveness of PIM in patients with LBP and to compare it with the effectiveness of manual mobilization.

METHODS

This is a double blind, randomized clinical trial. Thirty-two participants with LBP were randomly assigned to one of two groups. The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education; and the manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education. Both groups had a total of 4 treatment sessions over 2-3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions: Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) scale, Pressure pain threshold (PPT), lumbar spine range of motion (ROM), and lumbar multifidus muscle activation.

RESULTS

There were no differences between the PIM group and the manual group in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm2), lumbar spine ROM (PIM: ⩽ 9.49∘, Manual: ⩽ 0.88∘), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm).

CONCLUSIONS

Both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other.

Physical Predictors of Favorable Postoperative Outcomes in Patients Undergoing Laminectomy or Laminotomy for Central Lumbar Spinal Stenosis: Secondary Analysis of a Randomized Controlled Trial

Study Design

Secondary analysis of a randomized controlled trial.

Objective

To identify preoperative physical variables associated with favorable postoperative outcome in individuals undergoing laminectomy or laminotomy for degenerative central lumbar spinal stenosis.

Summary of Background Data

Clinical or condition specific variables have most commonly been studied as predictors of postoperative outcome in lumbar spinal stenosis. If associated to favorable postoperative outcome, modifiable physical variables would inform prehabilitation interventions for patients with degenerative central lumbar spinal stenosis.

Methods

Patients awaiting surgery for central lumbar spinal stenosis were recruited to participate in a randomized controlled trial. Following baseline data collection of demographics, clinical portrait and physical testing, participants were randomized to either 6-week active prehabilitation program or hospital standard care. Complete baseline and postoperative data were obtained from 58 participants which were included in the present analysis. Favorable postoperative outcome was determined based on two outcome measures. Favorable outcome was defined as a decrease of ≥30% on the Numerical Rating Scale for leg pain intensity and a decrease of ≥30% on the Oswestry Disability Index for low back disability. Baseline physical variables were used to conduct binary logistic regression.

Results

Sixty percent of participants were determined as having a favorable postoperative outcome. None of the included physical variables were found to be predictors of a favorable postoperative outcome based on leg pain intensity and low back pain-associated disability [trunk flexors muscle strength (OR = 0.73; 95%CI (0.02–27.12)] lumbar extensors muscle endurance [OR= 1.09; 95%CI (0.95–1.24)] total ambulation time [OR = 1.00 95%CI (0.99–1.01)] lumbar active range of motion in extension [OR = 1.08; 95%CI (0.95–1.23)] and knee extensors muscle strength [OR=1.02; 95%CI (0.98–1.06)].

Conclusion

Results show that none of the investigated variables, all related to low back and lower limbs physical capacity, were predictors of postoperative recovery. Further testing in larger cohort is needed to assess the full potential of physical outcome measures as predictors of postoperative recovery.

Comparing the Effects of Early Versus Late Exercise Intervention on Pain and Neurodynamic Mobility Following Unilateral Lumbar Microdiscectomy: A Pilot Study

STUDY DESIGN

A pilot, two-group pretest-posttest randomized controlled, single blinded study.

OBJECTIVE

Our study aim was to compare the changes in low back pain level, fear avoidance, neurodynamic mobility, and function after early versus later exercise intervention following a unilateral lumbar microdiscectomy.

SUMMARY OF BACKGROUND DATA

Exercise is commonly recommended to patients following a lumbar microdiscectomy although controversy remains as to the timing and protocols for exercise intervention.

METHODS

Forty patients were randomly allocated to early (Group 1) or later (Group 2) exercise intervention group. The low back pain and fear avoidance were evaluated using Oswestry Low Back Pain Disability Questionnaire, Numeric Pain Rating Scale, and Fear-Avoidance Beliefs Questionnaire. The neurodynamic mobility and function were recorded with Dualer Pro IQ Inclinometer, 50-foot walk test, and Patient-Specific Functional Scale. Two-sided t test for continuous variables and chi-square or Fisher exact test for categorical variables were used to compare the two groups' demographic data. The Wilcoxon signed-rank and rank-sum tests were used to compare the changes and the differences, respectively, in low back pain, fear avoidance, neurodynamic mobility, and function between baseline (before surgery) and postoperative repeated measurements (at 1-2, 4-6, and 8-10 wks after surgery) within each study group, after exercise intervention.

RESULTS

Both groups showed a significant decrease in low back pain levels and fear avoidance as well as a significant improvement in neurodynamic mobility and function at 4 and 8 weeks after surgery. However, no significant difference was reported between the two groups.

CONCLUSION

Our study results showed that early exercise intervention after lumbar microdiscectomy is safe and may reduce the low back pain, decrease fear avoidance, and improve neurodynamic mobility and function. A randomized controlled trial is needed to evaluate the early exercise intervention's effectiveness after lumbar microdiscectomy, and thus validate our findings.Level of Evidence: 4.

Effectiveness of an exercise-based prehabilitation program for patients awaiting surgery for lumbar spinal stenosis: a randomized clinical trial

Lumbar spinal stenosis is the most common reason for spine surgery in older adults, but the effects of prehabilitation on perioperative outcomes among these patients have not been investigated. This study aims to evaluate the effectiveness of a preoperative exercise-based intervention program compared with usual care on the improvement of clinical status, physical capacities and postoperative recovery of patients awaiting surgery for lumbar spinal stenosis. Sixty-eight participants were randomised to receive either a 6-week supervised exercise-based prehabilitation program or hospital usual care. The outcomes included both clinical and physical measures. Data collection occurred at post-intervention, and 6 weeks, 3- and 6-months post-surgery. Significant but small improvements were found in favour of the experimental group at the post-intervention assessment for pain intensity, lumbar spinal stenosis-related disability, lumbar strength in flexion, low back extensor muscles endurance, total ambulation time, and sit to stand performance. A significant difference in favor of the intervention group was found starting at the 3-month postoperative follow-up for low back-related disability. No adverse events were reported. Exercise-based prehabilitation did not improve short-term postoperative recovery in patients with lumbar spinal stenosis.

A Comparison of Clinical Spinal Mobility Measures to Experimentally Derived Lumbar Spine Passive Stiffness

Spinal stiffness and mobility assessments vary between clinical and research settings, potentially hindering the understanding and treatment of low back pain. A total of 71 healthy participants were evaluated using 2 clinical assessments (posteroanterior spring and passive intervertebral motion) and 2 quantitative measures: lumped mechanical stiffness of the lumbar spine and local tissue stiffness (lumbar erector spinae and supraspinous ligament) measured via myotonometry. The authors hypothesized that clinical, mechanical, and local tissue measures would be correlated, that clinical tests would not alter mechanical stiffness, and that males would demonstrate greater lumbar stiffness than females. Clinical, lumped mechanical, and tissue stiffness were not correlated; however, gradings from the posteroanterior spring and passive intervertebral motion tests were positively correlated with each other. Clinical assessments had no effect on lumped mechanical stiffness. The males had greater lumped mechanical and lumbar erector spinae stiffness compared with the females. The lack of correlation between clinical, tissue, and lumped mechanical measures of spinal stiffness indicates that the use of the term "stiffness" by clinicians may require reevaluation; clinicians should be confident that they are not altering mechanical stiffness of the spine through segmental mobility assessments; and greater resting lumbar erector stiffness in males suggests that sex should be considered in the assessment and treatment of the low back.

Reliability and concurrent validity of a mobile application to measure thoracolumbar range of motion in low back pain patients

BACKGROUND

Smartphone devices have been used to measure range of motion (ROM) in different joints.

OBJECTIVE

To verify the concurrent validity of thoracolumbar ROM using a mobile application and a digital inclinometer, as well as the intrarater reliability of individuals with and without back pain.

METHODS

One investigator was responsible for measuring the ROM during the evaluations performed on 20 asymptomatic subjects and 20 symptomatic subjects in two consecutive days.

RESULTS

Regarding to the concurrent validity, the Intraclass Correlation Coefficients (ICC) were classified as very good for all analyzed movements. For intrarater reliability, the mobile application had ICC varying between good and very good for the symptomatic subjects and very good for asymptomatic subjects.

CONCLUSIONS

The mobile application may be considered a valid and reliable tool to assess thoracolumbar ROM for both asymptomatic and chronic low back pain subjects.

Judokas with low back pain have lower flexibility of the hip-spine complex: A case-control study

OBJECTIVE

Study whether male adult judokas with and without low back pain (LBP) have different hip-spine flexibility.

DESIGN

Cross-sectional.

SETTING

Judo training centres.

PARTICIPANTS

Judokas with (n = 29) and without (n = 33) LBP.

MAIN OUTCOME MEASURES

Range of motion (ROM) (passive and active rotations) of hips, lumbar spine (flexion-extension) and fingertip-to-floor distance (FTFD).

RESULTS

The non-dominant hips of judokas with LBP had 6.8 ± 1.2° (ES:1.45, p < 0.001) lower passive and 8.0 ± 1.3° (ES:1.55, p < 0.001) lower active internal rotation. Dominant hips of judokas with LBP had 5.1 ± 1.6° (ES: 0.81, p = 0.002) lower active internal rotation and 8.8 ± 2.9° (ES:0.79, p = 0.003) lower active total rotation. The LBP group showed 8.0 ± 2.8° (ES: 0.73, p = 0.006) lower flexion and 6.0 ± 2.2° (ES: 0.69, p = 0.009) lower extension of the lumbar spine. The FTFD in the LBP group was 7.3 ± 2.6 cm (ES: 0.72, p = 0.007) lower. The multi-level regression analyses showed passive (OR 1.54, 95%CI 1.18-2.00, p = 0.001) and active (OR 1.47, 95%CI 1.16-1.87, p = 0.001) hip internal rotation of the non-dominant leg and lumbar spinal flexion (OR 1.11, 95%CI 1.03-1.20, p = 0.006) and extension (OR 1.16, 95%CI 1.01-1.33, p = 0.035) were related to LBP.

CONCLUSION

Lower hip internal rotation of the non-dominant leg (passive and active) and lower lumbar flexibility are significantly related to LBP in male adult judokas.

Comparison of Two Handheld Digital Dual Inclinometry Techniques in the Measurement of Lumbar Flexion Active Range of Motion

CONTEXT

An accurate assessment of lumbar spine active range of motion (AROM) is clinically important. Dual inclinometry is recommended as the optimal technique for measuring lumbar flexion AROM; however, the procedures differ in the literature.

OBJECTIVE

To compare 2 different handheld digital dual inclinometry (HDDI) techniques for evaluating lumbar flexion AROM.

DESIGN

The study was a repeated-measures design consisting of 2 trials.

SETTING

Laboratory.

PARTICIPANTS

A sample of 69 adult volunteers (28 men and 41 women; mean age 23.8 [2.4] y) without pain or injury to their back, hips, or abdomen for at least 3 months participated in the study.

INTERVENTION

Using standardized methods, 1 trained tester performed 2 different HDDI measurements of standing lumbar flexion AROM on each subject. Each subject performed one repetition of AROM lumbar flexion per HDDI measurement. The HDDI measures differed in the process for placing the upper inclinometer, with one technique identifying the upper landmark by skilled palpation of the T12 spinous process and the other technique by measuring 15-cm cephalad to the S2 region landmark to approximate the location of the T12 spinous process.

MAIN OUTCOME MEASURES

A dependent t test, Pearson correlation coefficient (r), the 95% limits of agreement, and Bland-Altman plots were used to examine agreement between the techniques.

RESULTS

Dependent t testing showed no significant differences between the techniques (mean difference = 1.2°, P = .11). A strong correlation existed between the 2 HDDI techniques (r = .80, P < .001). The Bland-Altman plot illustrated that 64 of the 69 data points were within the 95% limits of agreement for the 2 techniques.

CONCLUSIONS

The findings suggest that HDDI measurements of lumbar flexion AROM are comparable when using either of the 2 HDDI techniques described. Clinicians can make an evidence-based choice for using either method of measuring lumbar flexion AROM.

Immediate effects and associations between interoceptive accuracy and range of motion after a HVLA thrust on the thoracolumbar junction: A randomised controlled trial

BACKGROUND

There is paucity in the literature regarding the role of interoceptive accuracy (IAc) at predicting the effectiveness of osteopathic techniques which increase spinal mobility when directed specifically at the thoracolumbar junction (TLJ).

AIMS

The study aimed to explore whether a high velocity, low amplitude (HVLA) thrust of the TLJ would increase spinal mobility (measured through Range of Motion; ROM) and change IAc. Also, whether baseline IAc correlated with the post-ROM measures and change in ROM.

METHOD

21 asymptomatic participants were allocated into three conditions in a randomised order. These were; (1) a high velocity low amplitude manipulation of the TLJ; (2) sham (basic touch); and (3) a control (laying supine on a plinth). Before and following each intervention, the participants' spinal ROM was measured using an Acumar digital inclinometer. In addition to this an ECG was used to measure their pre and post condition IAc.

RESULTS

There were significant increases in ROM for all condition, however, the HVLA thrust led to a significantly greater increase in ROM (p < 0.001) when compared to the control and sham. Baseline IAc was inversely associated with post-ROM but there was no association with change in ROM. The HVLA thrust did not significantly change IAc scores from pre to post intervention.

CONCLUSIONS

HVLA thrust over the TLJ is a useful intervention for increasing spinal ROM. IAc maybe a useful predictor for intervention effectiveness of this technique and spinal area which could in the future be utilised by osteopaths as part of their diagnostics.

Effects of High - Intensity Laser in Treatment of Patients with Chronic Low Back Pain

BACKGROUND:

Chronic low back pain lasts longer than 12 weeks and is characterised by pain, muscle weakness, reduced functional ability and psychosocial burden.

AIM:

To compare the effects of two physical modalities, high-intensity laser against ultrasound therapy in the treatment of patients with chronic low back pain.

MATERIAL AND METHODS:

This was a prospective, monocentric, controlled clinical study comprising a group of 54 patients at the age between 25 and 65 years. Patients were divided into two groups: an examined group of 27 patients (high-intensity laser and exercises) and a control group of 27 patients (ultrasound therapy and exercises). The results were evaluated by the Numeric Pain Rating Scale, Oswestry Disability Index and Schober’s test. Clinical findings were evaluated at the same time points for all patients, before treatment, at two weeks and three months following treatment. Statistical analyses were made to compare the differences between the results obtained on admission and the two consecutive control check-ups. Statistical significance was defined as a P value < 0.05.

RESULTS:

The examined group showed statistically significantly better results than the control group after completion of the treatment (at two weeks) and at follow up after three months.

CONCLUSION:

This study has shown that patient with chronic low back pain treated with a high-intensity laser has significantly reduced low back pain, reduced disability and improved range of motion. Its positive effect maintained for three months. It seems to be an effective, safe and useful physical modality in the treatment of a patient with chronic low back pain.

The Immediate Effect of Therapeutic Touch and Deep Touch Pressure on Range of Motion, Interoceptive Accuracy and Heart Rate Variability: A Randomized Controlled Trial With Moderation Analysis

Background: There is paucity in the literature regarding the role of the interoceptive pathway through the insular cortex (IC), as well as heart rate variability (HRV) in relation to Osteopathic Manipulative Therapy (OMT) and deep-touch.

Aims: The present study investigated whether both OMT treatment and deep-touch (a newly hypothesized treatment option) was effective at altering the interoceptive pathway and HRV, whilst OMT was only expected to be effective for increasing Range of Motion (ROM).

Methods: Thirty-five healthy volunteers were randomly allocated into three conditions in a repeated measures crossover design; a control (laying supine on a plinth); deep-touch (head cradling); and an osteopathic mobilization therapeutic technique on the temporomandibular joint (TMJ). Interoceptive accuracy (IAc), HRV, as well as range of motion (ROM) for the TMJ area as well as the cervical spine (Csp) right and left measures were taken pre and post each condition setting.

Results: Significant condition effects emerged from the deep-touch and mobilization interventions for IAc where increases were identified through planned comparisons. For the HRV measure (RMSSD), a significant effect emerged in the deep-touch condition (increase) but not in the mobilization or control conditions. ROM did not increase for any condition. IAc correlated with post-ROM outcomes in many cases and HRV moderated some of these relations.

Conclusion: These results are discussed in the context of clinical practice, where cranial deep-touch maybe an effective treatment and modulator of the parasympathetic nervous systems, as well as the interoceptive system.

Lumbar Mobility and Performance-Based Function: An Investigation in Older Adults with and without Chronic Low Back Pain

Objective

To explore potential differences in lumbar mobility between older adults with and without chronic low back pain, and to determine if lumbar mobility contributes to physical performance in both groups. We hypothesized that older adults with pain would have greater lumbar mobility impairments than pain-free peers, and that lumbar mobility would be associated with performance in both groups, with stronger relationships among those with pain.

Design

Matched case-control.

Setting

Research laboratory.

Patients

Community-dwelling older adults, aged 60-85 years, with (N = 54) and without (N = 54) chronic low back pain.

Methods

Inclinometer-measured maximal angles of lumbar flexion, extension, and average side-bending, as well as time to complete performance measures, Repeated Chair Rise and Timed-Up-and-Go, were measured in both groups. Analysis of variance was used to explore the difference in lumbar mobility between groups. Adjusted linear regression was used to assess the independent relationship between lumbar mobility and physical function in both groups.

Results

Those with pain had smaller angles of flexion ( P = 0.029) and extension ( P = 0.013). In the pain group, flexion explained 19% ( P = 0.001) and 8.9% ( P = 0.006) of the variance for time to complete the Repeated Chair Rise and Timed Up-and-Go tests, respectively. In the pain-free group, extension explained 12.7% ( P = 0.007) and 10.3% ( P = 0.008) of the variance for time to complete Repeated Chair Rise and Timed Up-and-Go tests, respectively.

Conclusion

Older adults with chronic low back pain have more lumbar mobility impairments. Lumbar mobility may be a contributing factor to decreased performance in older adults. Flexion may be most important to performance in those with pain, while extension may be vital in those without pain.