How is trunk muscle activity during forward bending in standing in chronic non-specific low back pain patients presenting with psychosocial characteristics such as fear avoidance beliefs, pain catastrophizing or kinesiophobia? A systematic review of the literature.

Low back pain (LBP) is the most common single reason for addressing the health care system due to musculoskeletal pain. More than 80% will experience LBP at some point in life; 6 - 10% of those experiencing LBP will develop persistent and chronic pain with great variance in level of disability and pain.
Research indicates that LBP is multifactorial and calls for a biopsychosocial model when approaching the patient experiencing LBP. Despite this recognition LBP is poorly understood. A factor for debate has been the contribution of pain-related fear regarding maintenance of chronicity. Recently the importance of not treating all patients with LBP in the same way but trying to provide stratified care has been highlighted resulting in better outcomes.

To investigate if there is a correlation between increased muscle activity in a subgroup of patients with chronic non-specific LBP with pain-related fear during standing forward bending.

A systematic review of available literature was conducted searching the databases Pubmed, EMBASE, CINAHL and The Cochrane Library databases from inception to March 2016. Searches used keywords related to LBP, electromyography, pain-related fear, motor control and the flexion relaxation phenomenon.
Quality assessment of included studies was conducted applying the Newcastle Ottawa Scale.

The literature search revealed 211 studies out of which six were included but reporting were on five different studies in the systematic review. Included studies were all observational studies; two case-control and three cross-sectional studies.
Included studies revealed measurements from two pairs of electrodes placed at the lumbar trunk muscles between L1 and L5 and one pair of electrodes placed at the abdominal wall.

Correlation between increased muscle activity during standing forward bending and the subgroup of interest was found. Based on the limited number of studies, results should be interpreted with caution.
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  • University of Dundee
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