The correlation of increased lumbar lordosis and muscle imbalance with low back pain

Uvod: Bolečina v križu je zelo pogosta zdravstvena težava in večina ljudi se z njo sooči vsaj enkrat v življenju. Glede na navedbe številnih avtorjev je položaj telesa v sagitalni ravnini eden izmed možnih vzrokov za pojav bolečine v križu. Sagitalno ravnovesje je eden izmed ciljev fizioterapevtskih obravnav, bistveni element pri ohranjanju le-tega pa je ledvena lordoza. Mišično-skeletna obolenja pogosto kažejo vzorce mišičnega neravnovesja, neravnovesju enega telesnega segmenta pa lahko sledijo kompenzatorne spremembe na drugih segmentih. Tako lahko bolečina izvira iz nepravilnosti telesne drže. Namen: Namen diplomskega dela je bil s pregledom literature ugotoviti vpliv povečane ledvene lordoze, anteriornega nagiba medenice in mišičnega neravnovesja na bolečino v križu. Metode dela: Opravljen je bil pregled literature, objavljene med leti 2000 in 2016. Za iskanje ustrezne literature sta bili uporabljeni podatkovni bazi CINAHL in PubMed. Uporabljene ključne besede so bile: anterior pelvic tilt, pelvic inclination, increased lumbar lordosis, low back pain, posture, pelvic (lower) crossed syndrome. Rezultati: V pregled literature je bilo upoštevajoč vključitvene kriterije vključenih osem raziskav. Povezanost položaja ledvene hrbtenice in medenice v stoječem položaju s kronično bolečino v križu je bila raziskana v vseh vključenih študijah, povezanost mišičnega neravnovesja z bolečino v križu je bila obravnavana v dveh raziskavah, v treh pa je bil raziskan tudi vpliv bolečine na kvaliteto življenja. V dveh raziskavah so vpliv povečane ledvene lordoze na prisotnost bolečine v križu potrdili, v šestih pa so povezanost med spremenljivkama ovrgli. Rezultati raziskav potrjujejo, da je mišično neravnovesje, bolj specifično šibkost abdominalnih mišic, povezano z bolečino v križu. Prav tako so ugotovili, da bolečina v križu bistveno vpliva na kvaliteto življenja pri ženskah, ne pa tudi pri moških. Razprava in zaključek: Glede na rezultate pregleda literature ne moremo potrditi teze, da je povečana ledvena lordoza vzrok za pojav bolečine v križu. Možno pa je, da je mišično neravnovesje povezano z opisano bolečino zaradi spreminjanja amplitude ali smeri sil, ki delujejo na ledveno hrbtenico.Introduction: Low back pain is a very common health problem and most people experience it at some point in their life. According to many authors, sagittal spinal alignment is thought to be one of the possible causes of low back pain. Sagittal balance is one of the goals of physiotherapeutic intervention and lumbar lordosis is a key feature in maintaining it. Musculoskeletal conditions frequently show patterns of muscle imbalance and imbalance in one part of the body may result in compensatory changes in other parts. It is possible that pain is caused by altered posture of the body. Purpose: The purpose of this diploma thesis was to determine the correlation of increased lumbar lordosis and muscle imbalance with low back pain using literature review. Methods: A review of the literature published between 2000 and 2016 was performed. We used databases CINAHL and PubMed to identify the appropriate studies. The key words used were: anterior pelvic tilt, pelvic inclination, increased lumbar lordosis, low back pain, posture, pelvic (lower) crossed syndrome. Results: Eight studies were included in the literature review. The correlation between the curvature of lumbar spine and the pelvis in the standing position with chronic low back pain was researched in all the studies included, the correlation of muscle imbalance with low back pain was considered in two of the studies, and three studies furthermore evaluated the influence of low back pain on health-related quality of life. The correlation between increased lumbar lordosis and low back pain was confirmed in two studies, however the relationship was not statistically significant in the other six studies. The results of the studies support the idea of the correlation between muscle imbalance, more specifically weakness of the abdominal muscles with low back pain. It was also concluded, that low back pain affects the quality of life in women, but not in men. Discussion and conclusion: Based on the results of this literature review, we cannot confirm the thesis that increased lumbar lordoses is a cause of low back pain. However, muscle imbalance might be related to back pain resulting from changing the magnitude or direction of acting forces on the lumbar spine