The relationship of lumbar flexion to disability in patients with low back pain

The relationship of lumbar flexion to disability in patients with low back pain,  by M Scott Sullivan Lisa Donegan Shoaf and Daniel L Riddle (Physical Therapy March 2000 vol. 80 no. 3 240-250)

is an interesting study


Patients completed the Roland-Morris Back Pain Questionnaire (RMQ), and the therapists assessed lumbar spine flexion AROM (active range of motion) using a dual-inclinometer technique at the initial visit and again at discharge.


Measures of lumbar flexion AROM should not be used as surrogate measures of disability. Lumbar spine flexion AROM and disability are weakly correlated, suggesting that flexion AROM measures should not be used as treatment goals.

Free full study here. it “sort of” breaks the link between spine mobility and future back trouble.

The study also draws some very interesting observations about therapist biases

As always,  this gives us another crop of references to follow up

6 muscles of the back are functionally different from limb muscles

Limb muscles create movement, torso muscles create stability.

The simple act of walking requires spine stability. There are no agonists and antagonists in the torso they are all required to stabilise force generated elsewhere in the body.

If your therapist treats your core muscles in the same way as limb muscles, they are simply going to extend the pain in your back

Elite performers generate force in their hips, and it is transmitted through a stiffened core.

Spinal Control: The Rehabilitation of Back Pain: State of the art and science
edited by Paul W. Hodges, Jacek Cholewicki, Jaap H van Diee

Do you slump?

I fix the backs of sedentary people and of several elite athletes, also middle range  Crossfit athletes.

One thing Ive notice about those with bad backs is their ability to push themselves beyond the call of duty.  In fact they have the reputation of being hard workers, motivated and always on the go!

The reality is , once the doors are closed, they  can head for the settee and slump. For hours!!!! They can happily stay in bed if allowed, and they can be very , very lazy.

Hard ( some would say obsessive) work can sometimes be matched by back destroying  activity elsewhere.