Comparison of Lumbopelvic Rotation Angle during Active Straight Leg Raise in Patients with Chronic Low Back Pain with and without Lumbar Segmental Instability

만성요통환자의 요추부 불안정성 유무에 따른 능동 하지직거상 시 요골반부 회전각의 차이

Yu, Chang-Woo;Kim, Suhn-Yeop

  • Received : 2015.08.19
  • Accepted : 2015.09.21
  • Published : 2015.11.30


PURPOSE: This study aimed to compare the degree of lumbopelvic rotation during the active straight leg raise (ASLR) test in chronic low back pain with and without lumbar segmental instability. METHODS: A total of 71 patients with chronic low back pain were recruited for this study. The subjects who tested positive for more than three of the five lumbar segmental instability tests (prone lumbar instability, lumbar passive extension test, anterior posterior mobility test, passive straight leg raise, age) were categorized into the lumbar segmental instability positive group. Patients who tested positive for less than three of the five tests were categorized into the lumbar segmental instability negative group. The lumbopelvic rotation was measured three times during ASLR and a mean was determined. Subjective heaviness during the ASLR was measured on 6 point scale. RESULTS: There was a statistically significant difference in the lumbopelvic rotation angle between the groups with and without lumbar segmental instability (p<.01). There was no significant difference in the subjective heaviness during ASLR. The mean lumbopelvic rotation angle during ASLR was $13.54{\pm}2.86^{\circ}$, and $8.81{\pm}2.47^{\circ}$ in the positive and negative groups, respectively (p<.01). The cut-off value of the lumbopelvic rotation during was $10.5^{\circ}$, the sensitivity was 82.9%, and the specificity was 80.6%. CONCLUSION: These results suggest that lumbopelvic rotation is more prevalent in patients without lumbar segmental instability. Clinically, this important when diagnosing chronic low back pain with lumbar segmental instability, as the lumbopelvic rotation angle during the ASLR test can be used to aid in diagnosis.


Active straight leg raise;Instability;Low back pain;Lumbopelvic rotation


  1. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192-300.
  2. Alqarni AM, Schneiders AG, Hendrick PA. Clinical tests to diagnose lumbar segmental instability: A systematic review. J Orthop Sports Phys Ther. 2011;41(3):130-40.
  3. Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl. 1989;230: 1-54.
  4. Bruno PA, Goertzen DA, Millar DP. Patient-reported perception of difficulty as a clinical indicator of dysfunctional neuromuscular control during the prone hip extension test and active straight leg raise test. Man Ther. 2014; 19(6):602-7.
  5. Delitto A, George SZ, Van Dillen LR, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1-57.
  6. Elia DS, Bohannon RW, Cameron D, et al. Dynamic pelvic stabilization during hip flexion: a comparison study. J Orthop Sports Phys Ther. 1996;24(1):30-6.
  7. Hebert JJ, Koppenhaver SL, Magel JS, et al. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: A crosssectional study. Arch Phys Med Rehabil. 2010;91(1): 78-85.
  8. Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84(12):1858-64.
  9. Hicks GE, Fritz JM, Delitto A, et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753-62.
  10. Hoffman SL, Johnson MB, Zou D, et al. Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain. Man Ther. 2011;16(4):344-50.
  11. Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine (Phila Pa 1976). 2003;28 (14):1593-600.
  12. Hungerford B, Gilleard W, Lee D. Altered patterns of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers. Clin Biomech (Bristol, Avon). 2004;19(5):456-64.
  13. Lee DG. The pelvic girdle(3rd ed). Edinburgh: Churchill Livingstone, 2004.
  14. Lee Hj, Kim Sy, Comparison of the Effects of Abdominal Draw-In and Expansion Maneuvers on Trunk Stabilization in Patients With Low Back Pain and Lumbar Spine Instability. Phys Ther Korea 2015;22(1):37-48.
  15. Liebenson C, Karpowicz AM, Brown SH, et al. The active straight leg raise test and lumbar spine stability. PM R. 2009;1(6):530-5.
  16. Linek P, Saulicz E, Wolny T, et al. Intra-rater reliability of B-mode ultrasound imaging of the abdominal muscles in healthy adolescents during the active straight leg raise test. PM R. 2015;7(1):53-9.
  17. Magee DJ. Instability & Stabilization: Theory and treatment. Seminar workbook. 2. 1999.
  18. Mens JM, Vleeming A, Snijders CJ, et al. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine (Phila Pa 1976). 2001;26(10):1167-71.
  19. Mens JM, Vleeming A, Snijders CJ, et al. Responsiveness of outcome measurements in rehabilitation of patients with posterior pelvic pain since pregnancy. Spine (Phila Pa 1976). 2002;27(10):1110-5.
  20. Mens JM, Vleeming A, Snijders CJ, et al. The active straight leg raising test and mobility of the pelvic joints. Eur Spine J. 1999;8(6):468-73.
  21. Noh KH, Kim JW, Kim GM, et al. The influence of dual pressure biofeedback units on pelvic rotation and abdominal muscle activity during the active straight leg raise in women with chronic lower back pain. J Phys Ther Sci. 2014;26(5):717-9.
  22. O KY, Jhung YJ, Park SB, et al. Comparison between computerized inclinometer and manual inclinometer in measuring whole spinal range of motion. Ann Rehabil Med. 2002;26(4):456-60.
  23. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13(4):371-9.
  24. Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5(4):390-6; discussion 97.
  25. Park KH, Ha SM, Kim SJ, et al. Effects of the pelvic rotatory control method on abdominal muscle activity and the pelvic rotation during active straight leg raising. Man Ther. 2013;18(3):220-4.
  26. Roussel NA, Nijs J, Truijen S, et al. Low back pain: Clinimetric properties of the trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising. J Manipulative Physiol Ther. 2007;30(4):270-8.
  27. Sa JM, Kim SY. The reliability and validity of the passive lumbar extension test and the prone instability test. Phys Ther Korea. 2011;18(3):85-93.
  28. Tateuchi H, Tsukagoshi R, Fukumoto Y, et al. Pelvic instability and trunk and hip muscle recruitment patterns in patients with total hip arthroplasty. J Electromyogr Kinesiol. 2013;23(1):151-8.
  29. Van Dillen LR, Sahrmann SA, Norton BJ, et al. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: A preliminary report. Arch Phys Med Rehabil. 2003;84(3):313-22.
  30. Vleeming A, Mooney V, Stoeckart R. Movement Stability and Lumbopelvic Pain (2nd ed). Churchill Livingstone. 2007.
  31. Wilke HJ, Wolf S, Claes LE, et al. Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine (Phila Pa 1976). 1995;20(2):192-8.
  32. Wiltse L, Rothman S. Spondylolisthesis: Classification, diagnosis and natural history. Semin Spine Surg. 1989; 1(1):78-94.