Is There a Relationship Between Lumbar Proprioception and Low Back Pain? A Systematic Review With Meta-Analysis.
To systematically review the relationship between lumbar proprioception and low back pain (LBP).



Four electronic databases (PubMed, EMBASE, CINAHL, SPORTDiscus) and reference lists of relevant articles were searched from inception to March-April 2014.



Studies compared lumbar proprioception in patients with LBP with controls or prospectively evaluated the relationship between proprioception and LBP. Two reviewers independently screened articles and determined inclusion through consensus.



Data extraction and methodologic quality assessment were independently performed using standardized checklists.



Twenty-two studies (1203 participants) were included. Studies measured lumbar proprioception via active or passive joint repositioning sense (JRS) or threshold to detection of passive motion (TTDPM). Data from 17 studies were pooled for meta-analyses to compare patients with controls. Otherwise, descriptive syntheses were performed. Data were analyzed according to measurement method and LBP subgroup. Active JRS was worse in patients compared with controls when measured in sitting (standard mean difference, .97; 95% confidence interval [CI], .31-1.64). There were no differences between groups measured via active JRS in standing (standard mean difference, .41; 95% CI, -.07 to .89) or passive JRS in sitting (standard mean difference, .38; 95% CI, -.83 to 1.58). Patients in the O'Sullivan flexion impairment subgroup had worse proprioception than the total LBP cohort. The TTDPM was significantly worse in patients than controls. One prospective study found no link between lumbar proprioception and LBP.



Patients with LBP have impaired lumbar proprioception compared with controls when measured actively in sitting positions (particularly those in the O'Sullivan flexion impairment subgroup) or via TTDPM. Clinicians should consider the relationship between sitting and proprioception in LBP and subgroup patients to guide management. Further studies focusing on subgroups, longitudinal assessment, and improving proprioception measurement are needed.
Arthritis and Musculoskeletal Research Group, University of Sydney, Faculty of Health Sciences, Sydney, Australia. Electronic address: mton7741@uni.sydney.edu.au.
Matthew Hoyan
MH
Tong
Arthritis and Musculoskeletal Research Group, University of Sydney, Faculty of Health Sciences, Sydney, Australia.
Seyed Javad
SJ
Mousavi
Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences Utrecht, Faculty of Health Care, Utrecht, The Netherlands.
Henri
H
Kiers
Arthritis and Musculoskeletal Research Group, University of Sydney, Faculty of Health Sciences, Sydney, Australia.
Paulo
P
Ferreira
Arthritis and Musculoskeletal Research Group, University of Sydney, Faculty of Health Sciences, Sydney, Australia.
Kathryn
K
Refshauge
MOVE Research Institute Amsterdam, Department of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
Jaap
J
van Dieën
D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology*; D008159:Lumbar Vertebrae; D009038:Motion; D011187:Posture; D011434:Proprioception; D012684:Sensory Thresholds; D021801:Zygapophyseal Joint / Q000503:physiopathology*
Low back pain; Proprioception; Rehabilitation