Original research
Clinical Evaluation of Scapular Positioning in Patients With Nonspecific Chronic Low Back Pain: A Case-Control Study

https://doi.org/10.1016/j.jcm.2017.08.003Get rights and content

Abstract

Objective

The purpose of this study was to investigate the position of scapula in patients with nonspecific chronic low back pain.

Methods

A total of 17 participants with a history of nonspecific chronic low back pain and 17 healthy participants in the same age, sex, and weight range were enrolled in this case-control study. Lateral scapular slide test and Lennie test were used for clinical evaluation of scapular position in the frontal plane using a tape measure. The data were analyzed using an independent t test.

Results

The results of lateral scapular slide test indicated that there were significant differences between patients with nonspecific chronic low back pain and healthy individuals in both left and right sides in 2 positions: shoulder in neutral position and shoulder at 40°-45° abduction. Also, in the Lennie test, there was only a significant difference between groups when we measured the distances from thoracic spinous process to the inferior angle of the scapula in both left and right sides.

Conclusion

This study indicated that upward rotation of the scapula can be seen in patients with nonspecific chronic low back pain.

Introduction

Nonspecific chronic low back pain (CLBP) is a common problem that can cause economic and social problems for an individual.1 It has been reported that imbalance in the length, function, and strength of the trunk and hip muscles can lead to low back pain.2

Myofascial slings are interconnected muscle chains that lead to trunk stability during movement and force transmission from the lower to upper limbs.3 Most muscle injuries occur in the same sling that leads to pain and imbalances and can provoke trigger points. A myofascial sling that plays a critical role in trunk extension is the posterior oblique sling, which is composed of erector spina, hamstring, gluteal maximus (GM), and latissimus dorsi muscles.3, 4, 5 The latissimus dorsi has a synergetic role with gluteus maximus through the thoracolumbar fascia in trunk extension.6 Kim et al3 reported a greater muscular activation pattern of latissimus dorsi in CLBP patients during prone hip extension test. When the function of gluteus maximus is reduced to control the lumbopelvic region, the contralateral latissimus dorsi may be activated to compensate GM insufficiency and spinal instability.3, 6 Laudner et al7 reported that there was a link between increased latissimus dorsi stiffness and scapular dyskinesia using kinematic analysis among asymptomatic collegiate swimmers. They stated that latissimus dorsi stiffness increased scapular upward rotation and posterior tilt; however, scapular internal rotation decreased during humeral elevation.7 Therefore, Laudner et al7 stated that latissimus dorsi stiffness affects the scapular movement because of its attachment to the inferior border of the scapula.

Regarding the greater muscular activation pattern of latissimus dorsi in CLBP patients3 and its attachment to the inferior border of the scapula, it seems that latissimus dorsi dysfunction could alter scapular position. To the best of our knowledge, no study has investigated scapular position in CLBP patients. Therefore, the purpose of the present study was to evaluate scapular position among participants with and without CLBP to improve knowledge about myofascial sling function in CLBP patients.

Section snippets

Methods

This case-control study involved a total of 17 participants with chronic low back pain within the past 3 months and 17 healthy participants recruited through leaflet advertising. All the participants were students at Shiraz University of Medical Sciences. Anyone with a history of fracture or spinal dislocation, cardiovascular disease, disk herniation, pregnancy, neuromuscular and musculoskeletal diseases, leg limb discrepancy, previous shoulder surgery, thoracic and/or shoulder girdle pain, or

Results

The results indicated that there were no significant differences in demographic variables between patients with nonspecific CLBP and healthy individuals (Table 1).

Table 2 lists the result of LSSTs for both groups. The findings revealed that there were significant differences between the 2 groups in both left and right sides in neutral position and shoulder at 40°-45° abduction. The other measurements were not statistically significant between the 2 groups.

Also, the results of the Lennie test

Discussion

The results indicated that the scapula’s upward rotation was identified in patients with CLBP. This result suggests that CLBP may affect the adjacent structures.

The thoracolumbar fascia is attached to internal and external oblique, transverse abdominis, latissimus dorsi, and gluteal maximus, which distributed load between upper and lower extremities.4 Additionally, latissimus dorsi muscle is attached to the inferior border of the scapula.7 Thus, the biggest change occurred in the inferior

Conclusions

We found scapula upward rotation in patients with chronic low back pain using clinical tests. This finding may be helpful when designing a therapeutic protocol for treating scapular asymmetry.

Funding Sources and Conflicts of Interest

This study was completed as part of a thesis written by Fereshteh Khaledi and Aref Sadat that was supported by Shiraz University of Medical Sciences. No conflicts of interest were reported for this study.

Contributorship Information

  • Concept development (provided idea for the research): A.S., F.K.

  • Design (planned the methods to generate the results): S.P., S.T., A.S., F.K.

  • Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): S.P., S.T.

  • Data collection/processing (responsible for experiments, patient management, organization, or reporting data): A.S., F.K.

  • Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): L.H.,

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