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Title: Low back position awareness in people with and without recurrent non-specific low back pain
Author: Phillips, Dean
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2013
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This thesis investigates position awareness of the low back, measured using an electrogoniometer, in participants with and without recurrent non-specific low back pain (NSLBP). The ability to appreciate body position and movement makes an essential contribution to control of posture and functional movement. Pain may impair this awareness and initiate or exacerbate joint damage. Impairment of position awareness in the low back has been reported in patients with chronic low back pain. In addition, work-related activities may impair positional awareness, particularly in people experiencing LBP. The accuracy, stability and through range test-retest reliability of the electrogoniometer was assessed. It was found to be a reliable measure of degrees during movement in the sagittal plane between 0 to +/- 60 degrees, when compared to measurements using a calibrated, highly accurate, bevel protractor (mean error differences below 0.5 degrees for all tests). Low back position awareness was measured before and after a shift of work, in sitting and standing, in 61 people with recurrent NSLBP and 40 without a history of LBP. In addition, secondary analysis investigated the effect of occupation (manual workers, sedentary workers, drivers) on position sense. Low back position awareness was also measured in 50 people with recurrent NSLBP and 50 without a history of LBP during mid-range of sagittal plane movement of the low back in sitting; and when trying to return to a "good" sitting posture. There were no differences between participants with and without recurrent NSLBP in repositioning accuracy of the low back during any of the studies. When investigating the effect of occupation however, only sedentary workers achieved the power required for analysis. People with LBP positioned their "good" sitting posture significantly closer to end-range of low back extension, than people without LBP (12.47 SD8.46, v’s 16.51 SD9.41 degrees respectively; P=0.026). Recurrent NSLBP and sedentary work-related activities did not affect accuracy of position awareness in the low back. In people with recurrent NSLBP however, the position of their "good" sitting posture closer to end-range low back extension could lead to greater compressive loading of pain-sensitive spinal tissue, as well as increases in facet joint forces and shear forces on discs. These mechanisms may be aetiologic in the recurrence and maintenance of LBP. This finding may have implications for clinical practice, with consideration perhaps given to assessing the position of "good" sitting posture and its relationship to end-range in patients with LBP. Future research should investigate this further in larger populations of people with and without LBP, including specific sub-groups of LBP.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available