Movement coordination impairment in non-specific low back pain: Understanding aberrant patterns of movement and our ability to change them

Observation of aberrant movement patterns during active forward bending is one criterion used to identify non-specific low back pain (NSLBP) patients with movement coordination impairment (MCI). Core stabilization exercise is an intervention strategy widely used with NSLBP patients. Evidence supports improvement in clinical outcomes (pain and function) following core stabilization; however, the ability of these exercises to modify trunk and pelvis movement patterns has not been investigated. While the utility of clinical observation of poor movement patterns can assist in identification of patients with MCI, methods to capture, describe, and quantify typical and aberrant trunk and pelvis movement patterns have not been adequately developed. Quantification of movement patterns would allow us to investigate the ability of core stabilization exercises to modify movement coordination and control. The purposes of this study were to 1) characterize temporal and spatial 3-dimensional, multi-segmental kinematic patterns that represent typical and aberrant patterns of movement during standing forward bend, and 2) determine the ability of core stabilization exercise to alter trunk and pelvis movement patterns. Findings demonstrated the lumbar spine segment is the key segment to observe for identification of sagittal plane deviation (DEV) and judder (JUD), while coordination between the lumbar spine and pelvis can be used to assess JUD and altered lumbopelvic rhythm (aLPR). Typical and aberrant movement patterns are described and graphical representation presented. Kinematic algorithms developed based on clinical observation and variables that quantify aberrance from a typical movement pattern were tested for reliability and validated with known groups (healthy controls and NSLBP). The algorithms and variables were used to identify each type of aberrant movement pattern and used to investigate the ability of an 8-week core stabilization exercise program to change movement. Results demonstrated significant reduction of DEV and aLPR and a trend toward reducing JUD toward typical patterns with medium effect size. Findings from these studies provide methodology for future studies into movement patterns in NSLBP patients and preliminary evidence for the ability of core stabilization exercise to modify trunk and pelvis movement coordination and control by restoration of appropriate trunk neuromuscular control.