Aberrant Lumbopelvic Movements Predict Prospective Functional Decline in Older Adults with Chronic Low Back Pain

Published:September 18, 2021DOI:


      • Aberrant movements had an independent negative effect on 12-month physical function.
      • Aberrant movements had an indirect effect on 12-month function through baseline function.
      • Aberrant movements appear to be predictive of functional decline in this population.



      To investigate if clinically observable aberrant lumbopelvic movements are associated with physical function at 12-month follow-up in older adults with chronic low back pain (CLBP), both directly and indirectly through baseline physical function.


      Secondary analysis of a yearlong prospective cohort study.


      Clinical Research Laboratory.


      Community-dwelling older adults with CLBP (N=250).


      Not applicable.

      Main Outcome Measures

      Data from 239 participants were analyzed. Participants were screened at baseline for aberrant lumbopelvic movements during active trunk flexion; total observable aberrant movements were recorded and summed (range 0-4). Latent constructs of physical function were developed from an array of perception-based and performance-based outcome measures at baseline and 12 months, respectively. Structural Equation Modeling was used to assess the direct effect of baseline aberrant movement score on the latent construct of 12-month physical function, and its indirect effect through baseline physical function.


      Aberrant movements were present in most participants (64.7%) and had a significant negative total effect on 12-month physical function (γ= -0.278, P<.001). Aberrant movement score's direct effect and indirect effect, through baseline functioning, were significantly negatively associated with physical function at 12-months, after adjusting for covariates (γ=-0.068, P=.038; γ= -0.210, P<.001, respectively).


      Aberrant lumbopelvic movements are associated with decreased physical function at 12-month follow-up in older adults with CLBP, independent of baseline physical function and covariates. Future studies should evaluate if screening for aberrant movements may inform prognostic and interventional efforts in this patient population.


      List of abbreviations:

      CLBP (chronic low back pain), F8WT (Figure-of-8 Walk Test), LBP (low back pain), QBPDS (Quebec Back Pain Disability Scale), TUG (timed Up and Go)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • GBD 2017 Disease and Injury Incidence and Prevalence Collaborators
        Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
        Lancet. 2018; 392: 1789-1858
        • Wu A
        • March L
        • Zheng X
        • et al.
        Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017.
        Ann Transl Med. 2020; 8: 299
        • Reid MC
        • Williams CS
        • Gill TM.
        Back pain and decline in lower extremity physical function among community-dwelling older persons.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 793-797
        • Rudy TE
        • Weiner DK
        • Lieber SJ
        • Slaboda J
        • Boston JR.
        The impact of chronic low back pain on older adults: a comparative study of patients and controls.
        Pain. 2007; 131: 293-301
        • Freburger JK
        • Holmes GM
        • Agans RP
        • et al.
        The rising prevalence of chronic low back pain.
        Arch Intern Med. 2009; 169: 251-258
        • Paeck T
        • Ferreira ML
        • Sun C
        • Lin CW
        • Tiedemann A
        • Maher CG.
        Are older adults missing from low back pain clinical trials? A systematic review and meta-analysis.
        Arthritis Care Res (Hoboken). 2014; 66: 1220-1226
        • Gombatto SP
        • D'Arpa N
        • Landerholm S
        • et al.
        Differences in kinematics of the lumbar spine and lower extremities between people with and without low back pain during the down phase of a pick up task, an observational study.
        Musculoskelet Sci Pract. 2017; 28: 25-31
        • Hernandez A
        • Gross K
        • Gombatto S.
        Differences in lumbar spine and lower extremity kinematics during a step down functional task in people with and people without low back pain.
        Clin Biomech (Bristol, Avon). 2017; 47: 46-52
        • Laird RA
        • Gilbert J
        • Kent P
        • Keating JL.
        Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis.
        BMC Musculoskelet Disord. 2014; 15: 229
        • Mazzone B
        • Wood R
        • Gombatto S.
        Spine kinematics during prone extension in people with and without low back pain and among classification-specific low back pain subgroups.
        J Orthop Sports Phys Ther. 2016; 46: 571-579
        • Seay JF
        • Van Emmerik RE
        • Hamill J.
        Low back pain status affects pelvis-trunk coordination and variability during walking and running.
        Clin Biomech (Bristol, Avon). 2011; 266: 572-578
        • Shum GL
        • Crosbie J
        • Lee RY.
        Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit.
        Spine (Phila Pa 1976). 2005; 30: 1998-2004
        • Shum GL
        • Crosbie J
        • Lee RY.
        Three-dimensional kinetics of the lumbar spine and hips in low back pain patients during sit-to-stand and stand-to-sit.
        Spine (Phila Pa 1976). 2007; 32: E211-E219
        • Cook C
        • Brismée JM
        • Sizer Jr., PS
        Subjective and objective descriptors of clinical lumbar spine instability: a Delphi study.
        Man Ther. 2006; 11: 11-21
        • Biely SA
        • Silfies SP
        • Smith SS
        • Hicks GE.
        Clinical observation of standing trunk movements: what do the aberrant movement patterns tell us?.
        J Orthop Sports Phys Ther. 2014; 44: 262-272
        • Denteneer L
        • Stassijns G
        • De Hertogh W
        • Truijen S
        • Van Daele U.
        Inter- and intrarater reliability of clinical tests associated with functional lumbar segmental instability and motor control impairment in patients with low back pain: a systematic review.
        Arch Phys Med Rehabil. 2017; 98 (151-64.e6)
        • Wattananon P
        • Ebaugh D
        • Biely SA
        • Smith SS
        • Hicks GE
        • Silfies SP.
        Kinematic characterization of clinically observed aberrant movement patterns in patients with non-specific low back pain: a cross-sectional study.
        BMC Musculoskelet Disord. 2017; 18: 455
        • Reuben DB
        • Siu AL
        • Kimpau S.
        The predictive validity of self-report and performance-based measures of function and health.
        J Gerontol. 1992; 47: M106-M110
        • Vaughan L
        • Leng X
        • La Monte MJ
        • Tindle HA
        • Cochrane BB
        • Shumaker SA
        Functional independence in late-life: maintaining physical functioning in older adulthood predicts daily life function after age 80.
        J Gerontol A Biol Sci Med Sci. 2016; 71 (Suppl 1): S79-S86
        • Kempen GI
        • van Heuvelen MJ
        • van den Brink RH
        • et al.
        Factors affecting contrasting results between self-reported and performance-based levels of physical limitation.
        Age Ageing. 1996; 25: 458-464
        • Bean JF
        • Olveczky DD
        • Kiely DK
        • LaRose SI
        • Jette AM.
        Performance-based versus patient-reported physical function: what are the underlying predictors?.
        Phys Ther. 2011; 91: 1804-1811
      1. Hicks GE, Pohlig RT, Coyle PC, et al. Classification of geriatric low back pain based on hip characteristics with a 12-month longitudinal exploration of clinical outcomes: findings from Delaware Spine Studies. Phys Ther; in press.

        • Deyo RA
        • Dworkin SF
        • Amtmann D
        • et al.
        Report of the NIH Task Force on research standards for chronic low back pain.
        J Pain. 2014; 15: 569-585
        • Ware LJ
        • Herr KA
        • Booker SS
        • et al.
        Psychometric evaluation of the revised Iowa Pain Thermometer (IPT-R) in a sample of diverse cognitively intact and impaired older adults: a pilot study.
        Pain Manag Nurs. 2015; 16: 475-482
        • Thorborg K
        • Petersen J
        • Magnusson SP
        • Hölmich P.
        Clinical assessment of hip strength using a hand-held dynamometer is reliable.
        Scand J Med Sci Sports. 2010; 20: 493-501
        • Butler AA
        • Menant JC
        • Tiedemann AC
        • Lord SR.
        Age and gender differences in seven tests of functional mobility.
        J Neuroeng Rehabil. 2009; 6: 31
        • Thorpe Jr, RJ
        • Koster A
        • Kritchevsky SB
        • et al.
        Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition study.
        J Gerontol A Biol Sci Med Sci. 2011; 66: 1114-1123
        • Lang IA
        • Llewellyn DJ
        • Alexander K
        • Melzer D.
        Obesity, physical function, and mortality in older adults.
        J Amer Geriat Soc. 2008; 56: 1474-1478
        • Hicks GE
        • Simonsick EM
        • Harris TB
        • et al.
        Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: the moderating role of back pain.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 1420-1424
        • Guralnik JM
        • Ferrucci L
        • Simonsick EM
        • Salive ME
        • Wallace RB.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Hicks GE
        • Fritz JM
        • Delitto A
        • Mishock J.
        Interrater reliability of clinical examination measures for identification of lumbar segmental instability.
        Arch Phys Med Rehabil. 2003; 84: 1858-1864
        • Kopec JA
        • Esdaile JM
        • Abrahamowicz M
        • Abenhaim L
        • Wood-Dauphinee S
        • Lamping DL
        • et al.
        The Quebec Back Pain Disability Scale. Measurement properties.
        Spine (Phila Pa 1976). 1995; 20: 341-352
        • Hicks GE
        • Manal TJ.
        Psychometric properties of commonly used low back disability questionnaires: are they useful for older adults with low back pain?.
        Pain Med. 2009; 10: 85-94
        • Simonsick EM
        • Newman AB
        • Nevitt MC
        • et al.
        Measuring higher level physical function in well-functioning older adults: expanding familiar approaches in the Health ABC study.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M644-M649
        • Simmonds MJ
        • Olson SL
        • Jones S
        • et al.
        Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain.
        Spine (Phila Pa 1976). 1998; 23: 2412-2421
        • Bohannon RW
        • Shove ME
        • Barreca SR
        • Masters LM
        • Sigouin CS.
        Five-repetition sit-to-stand test performance by community-dwelling adults: a preliminary investigation of times, determinants, and relationship with self-reported physical performance.
        Isokinet Exerc Sci. 2007; 15: 77-81
        • Tiedemann A
        • Shimada H
        • Sherrington C
        • Murray S
        • Lord S.
        The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people.
        Age Ageing. 2008; 37: 430-435
        • Cesari M
        • Kritchevsky SB
        • Newman AB
        • et al.
        Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study.
        J Am Geriatr Soc. 2009; 57: 251-259
        • Brach JS
        • Perera S
        • Studenski S
        • Newman AB.
        The reliability and validity of measures of gait variability in community-dwelling older adults.
        Arch Phys Med Rehabil. 2008; 89: 2293-2296
        • Perera S
        • Patel KV
        • Rosano C
        • Rubin SM
        • Satterfield S
        • Harris T
        • et al.
        Gait speed predicts incident disability: a pooled analysis.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 63-71
        • Studenski S
        • Perera S
        • Patel K
        • Rosano C
        • Faulkner K
        • Inzitari M
        • et al.
        Gait speed and survival in older adults.
        JAMA. 2011; 305: 50-58
        • Lin MR
        • Hwang HF
        • Hu MH
        • Wu HD
        • Wang YW
        • Huang FC.
        Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people.
        J Am Geriatr Soc. 2004; 52: 1343-1348
        • Shumway-Cook A
        • Brauer S
        • Woollacott M.
        Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test.
        Phys Ther. 2000; 80: 896-903
        • Rikli RE
        • Jones CJ.
        The Reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults.
        J Aging Phys Act. 1998; 6: 363
        • Harada ND
        • Chiu V
        • Stewart AL.
        Mobility-related function in older adults: assessment with a 6-minute walk test.
        Arch Phys Med Rehabil. 1999; 80: 837-841
        • Hess RJ
        • Brach JS
        • Piva SR
        • VanSwearingen JM.
        Walking skill can be assessed in older adults: validity of the Figure-of-8 Walk Test.
        Phys Ther. 2010; 90: 89-99
        • Welch SA
        • Ward RE
        • Kurlinski LA
        • et al.
        Straight and curved path walking among older adults in primary care: associations with fall-related outcomes.
        PM R. 2016; 8: 754-760
        • Kim KH
        • Bentler PM.
        Data Modeling: Structural Equation Modeling. Handbook of complementary methods in education research.
        Lawrence Erlbaum Associates Publishers, Mahwah2006: 161-175
        • Lt Hu
        • PM Bentler
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equ Modeling. 1999; 6: 1-55
        • Zhang Z.
        Structural equation modeling in the context of clinical research.
        Ann Transl Med. 2017; 5: 102
        • Zhang Z
        • Zheng C
        • Kim C
        • Van Poucke S
        • Lin S
        • Lan P.
        Causal mediation analysis in the context of clinical research.
        Ann Transl Med. 2016; 4: 425
        • Alessandri G
        • Zuffianò A
        • Perinelli E.
        Evaluating intervention programs with a pretest-posttest design: a structural equation modeling approach.
        Front Psychol. 2017; 8: 223
        • Muthén LK
        • Muthén BO.
        Mplus user's guide (Version 8).
        Muthén & Muthén, Los Angeles19982017
        • Hicks GE
        • Fritz JM
        • Delitto A
        • McGill SM.
        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: 1753-1762
        • Sions JM
        • Coyle PC
        • Velasco TO
        • Elliott JM
        • Hicks GE.
        Multifidi muscle characteristics and physical function among older adults with and without chronic low back pain.
        Arch Phys Med Rehabil. 2017; 98: 51-57
        • Hicks GE
        • Simonsick EM
        • Harris TB
        • et al.
        Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 882-887
        • Massé-Alarie H
        • Beaulieu LD
        • Preuss R
        • Schneider C.
        Corticomotor control of lumbar multifidus muscles is impaired in chronic low back pain: concurrent evidence from ultrasound imaging and double-pulse transcranial magnetic stimulation.
        Exp Brain Res. 2016; 234: 1033-1045
        • Goubert D
        • De Pauw R
        • Meeus M
        • et al.
        Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sectional study.
        Spine J. 2017; 17: 1285-1296
        • Ward SR
        • Kim CW
        • Eng CM
        • et al.
        Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability.
        J Bone Joint Surg Am. 2009; 91: 176-185
        • Suri P
        • Kiely DK
        • Leveille SG
        • Frontera WR
        • Bean JF.
        Trunk muscle attributes are associated with balance and mobility in older adults: a pilot study.
        PM R. 2009; 1: 916-924
        • Jacob ME
        • Travison TG
        • Ward RE
        • Latham NK
        • Leveille SG
        • Jette AM
        • et al.
        Neuromuscular Attributes Associated With Lower Extremity Mobility Among Community-Dwelling Older Adults.
        J Gerontol A Biol Sci Med Sci. 2019; 74: 544-549
        • Granacher U
        • Gollhofer A
        • Hortobágyi T
        • Kressig RW
        • Muehlbauer T.
        The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review.
        Sports Med. 2013; 43: 627-641
        • Shojaei I
        • Salt EG
        • Bazrgari B.
        A prospective study of lumbo-pelvic coordination in patients with non-chronic low back pain.
        J Biomech. 2020; 102109306
        • MacDonald D
        • Moseley LG
        • Hodges PW.
        Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain.
        Pain. 2009; 142: 183-188
        • MacDonald D
        • Moseley GL
        • Hodges PW.
        People with recurrent low back pain respond differently to trunk loading despite remission from symptoms.
        Spine (Phila Pa 1976). 2010; 35: 818-824
        • Hides JA
        • Richardson CA
        • Jull GA.
        Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.
        Spine (Phila Pa 1976). 1996; 21: 2763-2769
        • Kavcic N
        • Grenier S
        • McGill SM.
        Determining the stabilizing role of individual torso muscles during rehabilitation exercises.
        Spine (Phila Pa 1976). 2004; 29: 1254-1265