Back Proprioception: Evidence in 2016
This systematic review looked at 22 studies and concluded that when compared to asymptomatic controls those with chronic low back pain (LBP) perform significantly worse on active repositioning tests in sitting.
Although most studies have found no loss of proprioception in the general LBP population, proprioception / joint positioning test (JPS) has been found to be reduced in a subgroup of patients classified as belonging to the O’Sullivan flexion impairment subgroup.
…basically it is the group of LBP patients who sit slouched most of the times and have little awareness that they are even sitting in full lumbar flexion.
So how can PTs evaluate JPS for the lumbar spine in the clinic?
Note: I have no evidence to back up the following suggestions.
Step 1: An adjustable laser pointer is attached to the patient’s L5-S1 spinous process using a waist strap (www.starmatrehab.com).
Step 2: Have the patient sit in neutral / slight lumbar lordosis on a ball or a stool with their back 2 meters from the wall. They are then instructed to close their eyes and memorize that position. While in neutral, the laser pointer is adjusted so it is in the center of the wall target.
Step 3: The patient is instructed to keep their eyes closed and fully slouch (lumbar flexion) which moves the laser towards 6 O’clock on the wall target. Then they are instructed to return to neutral again as accurately as possible. This is repeated 3 times. If all 3 times they miss the entire 12cm target radius, poor prorioception may be considered.
Step 4: The same is repeated but this time the return to neutral test involves movement from exaggerated lordodic posture (lumbar extension).
This is repeated 3 times. If all 3 times they miss the entire 12cm target radius, poor prorioception may be considered.
So how can PTs train lumbar JPS in the clinic?
To train lumbar JPS using the STARmat and the laser, one only needs either a mirror or smart phone to take a selfie video. The patient may simply view their repositioning accuracy of the laser on their phone. Five minutes of focused postural awareness can have tremendous value.
For home program, no laser or phone is required, the patient is to simply sit, close their eyes and SLOWLY move from full lumbar flexion to neutral and from full lumbar extension to neutral. If needed, they may use their own hand to facilitate and “feel” the movement occurring in their spine.
Reference: Tong MH et al Is there a relationship between lumbar proprioception and low back pain? A systematic review with meta-analysis. Arch Phys Med Rehabil. 2016 Jun 15. pii: S0003-9993(16)30245-3.