Author's School

School of Medicine

ORCID

https://orcid.org/0000-0002-8846-5990

Author's Department/Program

Movement Science

Language

English (en)

Date of Award

5-15-2026

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Linda Van Dillen

Committee Members

Jennifer Zellers, Keith Lohse, Abby Cheng, Michael Harris

Abstract

Low back pain (LBP) is a significant and continually growing public health problem. While some people recover from an initial episode, a proportion will develop chronic or recurrent LBP that limits their ability to perform daily functional activities. The variable and often function-limiting course of LBP underscores the clear need for improved methods of assessment and treatment. One way to improve the assessment and treatment of LBP is to develop a more comprehensive understanding of factors that contribute to LBP. In this dissertation, we investigated two categories of factors that may contribute to a person’s LBP: (1) spinal movement impairments and (2) structural and functional factors related to the hip.

Spinal movement impairments are characterized by the lumbar spine moving more readily into its available range of motion than other joints that can contribute to the movement goal. Findings of prior work suggest the impairments are important in people with chronic LBP. In chapter 2, we examined whether the impairments are present or related to symptoms in people with acute LBP. We found that people with acute LBP display spinal movement impairments during clinical tests, and that modifying the impairment during the test is associated with an immediate improvement in symptoms. In chapter 3, we investigated whether hip factors contribute to specific spinal movement impairments during a representative clinical test and a functional test. We found that none of the hip factors examined were significantly associated with spinal movement impairments during either test. In chapter 4, we examined which, if any, hip factors uniquely contribute to LBP intensity or LBP-related functional limitations. There was a small association between hip strength and LBP-related functional limitations, while none of the other hip factors examined were associated with LBP intensity or LBP-related functional limitations.

Several important findings emerge from this dissertation. First, the results suggest that spinal movement impairments are present and clinically relevant in people with acute LBP, extending prior work that has largely focused on people with chronic LBP. Second, the findings indicate that alterations in hip factors may not be primary drivers of these impairments during clinical and functional tests. Finally, although hip strength demonstrated a small association with LBP-related functional limitations, hip factors overall were not consistently related to LBP intensity or LBP-related functional limitations. Results of this investigation provide valuable insights that could be used to better individualize patient care and potentially reduce the long-term burden of disability associated with the condition. Future research should further examine the role of spinal movement impairments across the course of acute LBP, explore additional mechanisms that may contribute to these impairments, and identify subgroups of individuals for whom hip-focused interventions may be most beneficial.

DOI

https://doi.org/10.48765/nvam-rj15

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