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Association between lower limb alignment and low back pain: A systematic review with meta-analysis
Saeedeh Abbasi1, Seyed Hamed Mousavi1, Fateme Khorramroo1
1Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran.
Plos One
|October 10, 2024
Summary
Lower extremity alignment, including increased pronation and internal rotation of the hip and knee, is linked to a higher risk of low back pain (LBP). Further research is needed to confirm these associations.
Area of Science:
- Orthopedics
- Biomechanics
- Public Health
Background:
- Low back pain (LBP) is a widespread and expensive global health issue.
- Identifying risk factors for LBP is crucial for effective management strategies.
- Lower extremity alignment is increasingly recognized as a significant factor in LBP development.
Purpose of the Study:
- To systematically review and meta-analyze existing evidence on the association between lower limb alignment and LBP.
- To enhance the understanding of the relationship between biomechanical factors of the lower extremities and LBP incidence.
- To synthesize findings from diverse study designs investigating lower limb alignment and LBP.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and Scopus databases.
- Inclusion criteria focused on case-control, cohort, and cross-sectional studies in English, examining LBP and lower limb alignment.
- Methodological quality was assessed using the Downs and Black checklist, with data meta-analyzed using RevMan 5.4.
Main Results:
- Thirteen studies involving 102,359 participants were included in the meta-analysis.
- Strong evidence indicates increased pronation is associated with an elevated risk of LBP (p = 0.02).
- Moderate and limited evidence suggests associations between increased hip internal rotation and knee internal rotation with LBP risk, respectively.
Conclusions:
- The meta-analysis provides evidence linking specific lower limb alignment issues, notably pronation, to an increased risk of low back pain.
- Heterogeneity in study designs and methodological limitations necessitate caution in drawing definitive conclusions.
- Future research should prioritize prospective cohort studies with objective alignment measures and standardized outcomes to clarify this relationship.
