Diagnostic value of trunk flexion–extension testing in old chronic low back pain patients

Abstract

Purpose

Dynamic trunk flexion–extension testing has been proven to objectively diagnose low back pain in persons under the age of 60 years but older persons have difficulty complying with standardized movement velocity.

Methods

190 patients and 71 matched healthy volunteers (18–90 years of age) performed modified testing by holding static positions at standing, half, and full trunk flexion.

Results

Lumbar extensor muscle activity in isometric positions was significantly higher in patients with higher activity in the oldest (60–90 years) and the middle-aged (40–59 years) but not in the youngest (18–39 years) subgroups compared to normal. There were no differences in gross trunk range of motion, half flexion relaxation ratio, proprioception, muscle activity differences between positions, and fear-avoidance behavior. The diagnostic accuracy as expressed by the area under the curve was fair (0.74).

Conclusions

Lumbar extensor muscle activity demonstrated moderate to good diagnostic value in old patients.

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Abbreviations

RMS SEMG:

Root mean square surface electromyography (–ic)

ROM:

Range of motion

MVC:

Maximum voluntary contraction

HFR:

Half flexion relaxation ratio

PRM:

Physical medicine and rehabilitation

3d-accelerometer:

Three dimensional accelerometer

L5:

Lumbar spine level 5

T4:

Thoracic spine level 4

s:

Second

kg/m2 :

Kilogram per square meter

ROC:

Receiver operating analysis

AUC:

Area under the curve

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Acknowledgments

The authors gratefully thank Haley Milko for providing English language corrections.

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Correspondence to Thomas Kienbacher.

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In the past 5 years, we have not received reimbursements, fees, funding, financing of the manuscript, or salary from an organization that may in any way gain or lose financially from the publication of this manuscript, either now or in the future.

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Kienbacher, T., Fehrmann, E., Habenicht, R. et al. Diagnostic value of trunk flexion–extension testing in old chronic low back pain patients. Eur Spine J 26, 510–517 (2017). https://doi.org/10.1007/s00586-016-4758-z

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Keywords

  • Electromyography
  • Kinematics
  • Proprioception
  • Chronic back pain
  • Healthy volunteers