Larsson et al. (2024)

Lumbopelvic Movement Control in Powerlifters and the Association with Low Back Pain

This study examined the relationship between lumbopelvic movement control in powerlifters with and without low back pain

A test battery based on previous research was used to assess lumbopelvic control

There were no significant differences in total scores between powerlifters with and without low back pain

Introduction

The ability to stabilize and regulate the pelvis and lower back while moving other body parts is known as lumbopelvic movement control. It is thought to be important to prevent injuries and lower back pain. In the general population, associations have been found between distorted lumbopelvic movement control in people with low back pain, compared to people without. As such it is commonly considered to be a risk factor for the onset or development of low back pain and it is thought to have a negative impact on treatment when there is a lack of control in this area. Powerlifters frequently report injuries in the area of the pelvis and lower back and as such, lumbopelvic movement control in powerlifters is regarded as essential to protect the spine from the large compressive forces. However, despite poor control being frequently blamed, this theory of lumbopelvic movement control in powerlifters has never been examined, so it remains unclear whether it is to be seen as a risk factor. That’s why this study assessed lumbopelvic movement control in powerlifters with and without low back pain.

 

Methods

Powerlifters with low back pain of a minimal intensity of 1/10 on the VAS and minimal duration of 4 weeks, who reported activity limitations in the squat, bench press, and/or deadlift because of their back pain were possible candidates for inclusion. The activity limitations were measured using a modified version of the Patient-Specific Functional Scale (PSFS). An activity limitation was defined as a score lower than 10 in any of the three powerlifting components.

To assess lumbopelvic movement control in powerlifters, the authors used a test battery as described by Luomajoki et al. (2007 & 2008) for their cross-sectional study. In short, this test battery consisted of 7 tests:

  • Waiter’s bow (flexion control)
  • Standing posterior pelvic tilt (flexion control)
  • One-leg stance (lateral shift control)
  • Sitting knee extension (flexion/rotation control)
  • Quadruped rocking forward (extension control)
  • Quadruped rocking backward (flexion control)
  • Prone knee flexion (extension/rotation control)
lumbopelvic movement control in powerlifters
From: Larsson et al., Phys Ther Sport. (2024)

 

lumbopelvic movement control in powerlifters
From: Larsson et al., Phys Ther Sport. (2024)

 

All tests were video recorded while they were conducted 3 times per test position. Hereafter, the videos were visually evaluated by a blinded physiotherapist for correctness. A test was executed incorrectly when the athlete failed to regain the correct start position in any of the three repetitions. A total score was calculated and ranged from 0-13.

Further, they completed a background questionnaire regarding their current training and competition and current injuries. The Roland-Morris Disability Questionnaire and the NPRS were also recorded.

 

Results

40 powerlifters were included in this study. Twelve participants had low back pain and 28 did not. They were comparable across the groups at baseline.

lumbopelvic movement control in powerlifters
From: Larsson et al., Phys Ther Sport. (2024)

 

They had similar training and competition characteristics.

lumbopelvic movement control in powerlifters
From: Larsson et al., Phys Ther Sport. (2024)

 

The test battery assessing lumbopelvic movement control in powerlifters revealed no significant differences in total scores between powerlifters with and without low back pain.

lumbopelvic movement control in powerlifters
From: Larsson et al., Phys Ther Sport. (2024)

 

When the different tests to assess lumbopelvic movement control were compared between the powerlifters with and without low back pain, no significant differences were found.

lumbopelvic movement control in powerlifters
From: Larsson et al., Phys Ther Sport. (2024)

 

As such, there were no significant differences in the percentages of participants scoring positive on the lumbopelvic movement control tests.

lumbopelvic movement control in powerlifters
From: Larsson et al., Phys Ther Sport. (2024)

 

Questions and thoughts

What does this mean? Either powerlifters with low back pain have no different lumbopelvic movement control compared to powerlifters without or these tests cannot detect faulty movement control or both.

A systematic review by Aasa et al. (2020) found no difference in the prevalence or severity of pathoanatomical findings in the lumbar spine when they compared powerlifters with and without low back pain. This would mean that lumbopelvic movement control in powerlifters is not related to injury. Many studies of the same research group found that experienced powerlifters and weightlifters do adapt their lumbopelvic positions during squats and deadlifts and do not maintain a “stable neutral position” of the spine. This could mean that the lumbopelvic area should adapt to efficiently lift these heavy loads, as we also reviewed in our research review of Mawston et al., (2021). Maybe, instead of a movement impairment, we could call it a movement optimization. After all, the spine is built to adapt, so why shouldn’t it?

But what about the differences in lumbopelvic movement control in people with and without low back pain from the general population? Even if there is a difference between people with and without low back pain, this does not mean that people with distorted movement control of the lumbopelvic area developed low back pain due to these adaptations. Maybe, they found a way to keep moving. They may compensate or have less or altered variation in their movements.

What has to be taken into account is the presence of other musculoskeletal injuries in other body parts. The body parts injured other than the lower back were the hip/groin/thigh, thorax, knee, foot, shoulder, elbow, and wrist. This could also have influenced the movements but, no differences were observed between the powerlifters with and without low back pain.

 

Talk nerdy to me

In our research review by Areeudomwong et al. (2020), we already discussed the issue of not having a perfect gold standard, which was also the case in this study. The test battery described by Luomajoki et al. (2007, 2008) is a visual observation of movements in the spine. The authors found it to have moderate inter- and intra-rater reliability. However, as there is no gold standard to compare it to, the validity of these tests cannot be assumed. The authors indicated that the test battery “potentially has” a degree of discriminative validity, which is quite vague.

Further, the movements were visually assessed and filmed so a blinded researcher could evaluate the movements. He was only able to watch the recording 1 time. We however know that visual inspection of movements generally has low reliability and in the absence of a true gold standard or more objective 3D-analysis, we should be very cautious in interpreting “movement faults and dysfunctions”.

The group of powerlifters with low back pain was much smaller than the group without. The authors emphasize that this increases the risk of finding false negative findings.

The groups were not matched but, given their comparability at baseline, this should not have posed an issue.

 

Take home messages

This study examined lumbopelvic movement control in powerlifters with and without low back pain using a test battery based on Luomajoki et al. (2007). There were no differences in movement control of the lumbopelvic area between the powerlifters experiencing low back pain and those not experiencing it. Since the tests showed no differences between the powerlifters with and without low back pain, we can assume that the presence of movement variation in the lumbopelvic area is not a contributing or risk factor for low back pain. Instead, it is possible that this merely reflects a functional movement optimization.

 

Reference

Larsson H, Strömbäck E, Schau M, Johansson S, Berglund L. Lumbopelvic movement control in powerlifters with and without low back pain. Phys Ther Sport. 2023 Dec 4;65:74-82. doi: 10.1016/j.ptsp.2023.11.006. Epub ahead of print. PMID: 38070289. 

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