Abstract
Purpose
Clinical observation suggests that hip abductor weakness is common in patients with low back pain (LBP). The purpose of this study is to describe and compare the prevalence of hip abductor weakness in a clinical population with chronic non-specific LBP and a matched sample without LBP.
Methods
One hundred fifty subjects with chronic non-specific LBP and a matched cohort of 75 control subjects were recruited. A standardized back and hip physical exam was performed. Specifically tensor fascia lata, gluteus medius, and gluteus maximus strength were assessed with manual muscle testing. Functional assessment of the hip abductors was performed with assessment for the presence of the Trendelenburg sign. Palpation examination of the back, gluteal and hip region was performed to try and reproduce the subject’s pain complaint. Friedman’s test or Cochran’s Q with post hoc comparisons adjusted for multiple comparisons was used to compare differences between healthy controls and people with chronic low back pain for both the affected and unaffected sides. Mann–Whitney U was used to compare differences in prevalence between groups. Hierarchical linear regression was used to identify predictors of LBP in this sample.
Results
Gluteus medius is weaker in people with LBP compared to controls or the unaffected side (Friedman’s test, p < 0.001). The Trendelenburg sign is more prevalent in subjects with LBP than controls (Cochran’s Q, p < 0.001). There is more palpation tenderness over the gluteals, greater trochanter, and paraspinals in people with low back pain compared to controls (Cochran’s Q, p < 0.001). Hierarchical linear regression, with BMI as a covariate, demonstrated that gluteus medius weakness, low back regional tenderness, and male sex were predictive of LBP in this sample.
Conclusion
Gluteus medius weakness and gluteal muscle tenderness are common symptoms in people with chronic non-specific LBP. Future investigations should validate these findings with quantitative measures as well as investigate the effect of gluteus medius strengthening in people with LBP.
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References
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R (2014) The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:968–974
Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American college of physicians and the american pain society. Ann Intern Med 147:478–491
Chou R, Huffman LH (2007) Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American pain society/American college of physicians clinical practice guideline. Ann Intern Med 147:492–504
van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 20:19–39
van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW (2010) Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 24:193–204
Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ (2012) Low back pain. J Orthop Sports Phys Ther 42:A1–57
Standaert CJ, Weinstein SM, Rumpeltes J (2008) Evidence-informed management of chronic low back pain with lumbar stabilization exercises. Spine J 8:114–120
Mayer J, Mooney V, Dagenais S (2008) Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises. Spine J 8:96–113
Simons DG, Travell JG (1983) Myofascial origins of low back pain. 3. Pelvic and lower extremity muscles. Postgrad Med 73(99–105):108
Njoo KH, Van der Does E (1994) The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain 58:317–323
Bewyer DC, Bewyer KJ (2003) Rationale for treatment of hip abductor pain syndrome. Iowa Orthop J 23:57–60
Nourbakhsh MR, Arab AM (2002) Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther 32:447–460
Arab A, Nourbakhsh M (2010) The relationship between hip abductor muscle strength and iliotibial band tightness in individuals with low back pain. Chiropr Osteopat 18:1
Kendall KD, Schmidt C, Ferber R (2010) The relationship between hip-abductor strength and the magnitude of pelvic drop in patients with low back pain. J Sport Rehabil 19:422–435
Bewyer KJ, Bewyer DC, Messenger D, Kennedy CM (2009) Pilot data: association between gluteus medius weakness and low back pain during pregnancy. Iowa Orthop J 29:97–99
Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M (2002) Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc 34:9–16
Nelson-Wong E, Gregory DE, Winter DA, Callaghan JP (2008) Gluteus medius muscle activation patterns as a predictor of low back pain during standing. Clin Biomech 23:545–553
Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy JD, Rossignol M, Leboeuf-Yde C, Hartvigsen J, Leino-Arjas P, Latza U, Reis S, Gil Del Real MT, Kovacs FM, Oberg B, Cedraschi C, Bouter LM, Koes BW, Picavet HS, van Tulder MW, Burton K, Foster NE, Macfarlane GJ, Thomas E, Underwood M, Waddell G, Shekelle P, Volinn E, Von Korff M (2008) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 33:95–103
Hislop HJ, Montgomery J (2002) Daniels and Worthingham’s muscle testing : techniques of manual examination. Saunders, Philadelphia
Trendelenburg F (1998) Trendelenburg’s test: 1895. Clin Orthop Relat Res 355:3–7
Hardcastle P, Nade S (1985) The significance of the Trendelenburg test. J Bone Joint Surg Br 67:741–746
Apeldoorn AT, Ostelo RW, van Helvoirt H, Fritz JM, Knol DL, van Tulder MW, de Vet HC (2012) A randomized controlled trial on the effectiveness of a classification-based system for subacute and chronic low back pain. Spine 37:1347–1356
Fairbank J, Gwilym SE, France JC, Daffner SD, Dettori J, Hermsmeyer J, Andersson G (2011) The role of classification of chronic low back pain. Spine 36:S19–S42
Hayden JA, van Tulder MW, Malmivaara A, Koes BW (2005) Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev 20(3):CD000335
Frese E, Brown M, Norton BJ (1987) Clinical reliability of manual muscle testing. Middle trapezius and gluteus medius muscles. Phys Ther 67:1072–1076
Krause DA, Neuger MD, Lambert KA, Johnson AE, DeVinny HA, Hollman JH (2014) Effects of examiner strength on reliability of hip-strength testing using a handheld dynamometer. J Sport Rehabil 23:56–64
Acknowledgments
This work was supported by the Department of Rehabilitation Therapies at the University of Iowa Hospitals and Clinics; the Department of Physical Therapy and Rehabilitation Science at the Carver College of Medicine at the University of Iowa; and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1RR024979.
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Cooper, N.A., Scavo, K.M., Strickland, K.J. et al. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J 25, 1258–1265 (2016). https://doi.org/10.1007/s00586-015-4027-6
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DOI: https://doi.org/10.1007/s00586-015-4027-6