Effect of active limb movements on symptoms in patients with low back pain

Study Design: A descriptive, correlational study of patients with mechanica l low back pain (LBP). Objectives: To assess the effect of active limb move ments on symptoms in patients with LBP and to examine the relationship betw een symptoms with limb movements and select patient characteristics. Background: Limb movements result in forces applied to the spine and, thus, may be important in the examination and treatment of patients with LBP. Methods and Measures: A total of 188 people with LBP, 84 men and 104 women, participated in a standardized examination. Six of the items required pati ents to move their limbs and note LBP symptoms as increased, remained the s ame, or decreased. The prevalence of various symptom responses with each li mb movement test was calculated. Relationships between patient characterist ics and reports of increased symptoms were examined with Cochran's linear t rend statistic and the Spearman and Pearson correlation coefficients. Diffe rences in characteristics of patients with and without increased symptoms w ere examined with chi (2), test, Mann-Whitney U test, or Student's t test f or independent groups. Results: An increase in symptoms was reported by 149 patients with at least I of the limb movement tests, and 3 of the patients reported a decrease in symptoms. Across the patient sample, the mean number of limb movement test s for which symptoms were reported as increased was 2.30 +/- 1.64. Patients with an increase in symptoms reported higher average pain intensity the we ek prior to the examination (median = 2; range: 1-5) and higher functional disability (mean 0.25; SD = 0.15) than those without a change in symptoms ( pain intensity: median = 1; range: 0-2 and functional disability: mean = 0. 16; SD = 0.12). The correlation between the number of increased symptoms an d the person's average pain intensity was r = 0.23; the correlation with th e functional disability score was r = 0.36. Patients with a history of LBP tended to report an increase in symptoms with more of the limb movement tes ts (mean = 3.5; SD = 1.40) than those without a previous history of LBP (me an = 2.0; SD = 1.11). Conclusions: Active limb movements performed during the examination primari ly resulted in increased LBP symptoms. The presence and number of increased symptoms with the active limb movements was related to the patient's repor t of average pain intensity and functional disability. Tests of symptoms wi th active limb movements may provide insight into factors contributing to a LBP problem, as well as information to guide the treatment of patients wit h LBP.