Investigating the contribution of the upper and lower lumbar spine, relative to hip motion, in everyday tasks

Background: It is commonplace for clinicians to measure range of motion (ROM) in the assessment of the lumbar spine. Traditional single 'joint' models afford measuring only a limited number of regions along the spine and may, therefore, over-simplify the description of movement. It remains to be determined if additional, useful information can be gleaned by considering the traditional 'lumbar region' as two regions. Objective: The aim of this study was to determine whether modelling the lumbar spine as two separate regions (i.e. upper and lower), yields a different understanding of spinal movement relative to hip motion, than a traditional single-joint model. This study is unique in adopting this approach to evaluate a range of everyday tasks. Method: Lumbar spine motion was measured both by being considered as a whole region (S1 to T12), and where the lumbar spine was modelled as two regions (the upper (L3-T12) and lower (S1-L3)). Results: A significant difference was evident between the relative contribution from the lower and upper spine across all movements, with the lower lumbar spine consistently contributing on average 63% of the total ROM. A significant difference was also evident between the whole lumbar spine-hip ratio, and the lower lumbar spine-hip ratio, for the movement of lifting only. The lower lumbar spine achieved greater velocity for all tasks, when compared to the upper lumbar spine. Conclusion: This study has consistently demonstrated differences in the contribution of the upper and lower spinal regions across a range of everyday tasks; hence, it would appear that greater focus should be given to performing more detailed assessments to fully appreciate spinal movement. (C) 2016 The Authors. Published by Elsevier Ltd.