Clinical Biomechanics 1989; 4: 64

Brief Report: Thesis Summary

Evaluation 0f.a technique for measuring lumbar lordosis in the clinical assessment occupational low back pain

Stephen Simpson MB, MFOM

Post Office, Colchester, UK

This preliminary study was designed to evaluate a poss- ible technique for the clinical measurement of spinal mobility and range of movement using a flexible ruler (flexicurve) .

The study population consisted of all manual grade British Steel Corporation employees (8000 men) based in Scotland. The subject group comprised men who were experiencing low back pain which radiated below the pelvis, and who had not been able to attend work for a period in excess of 4 weeks. Subjects who had under- gone spinal surgery were excluded. The pilot study lasted for 9 months, and during this time 31 subjects satisfied the protocol definitions.

The control group consisted of men who were ran- domly selected whilst attending a clinic for reasons other than low back pain. They had never been away from work for more than 4 weeks with back pain, and were not currently suffering back pain.

Employees were not further sub-divided according to their individual jobs. The steel industry in the UK has undergone a major transformation in recent years with the loss of thousandS of jobs. There are no ‘light jobs’, and all require a reasonable degree of mobility.

Spinal profile and range of movement measurements were obtained by using a draughtsman’s flexicurve,

Dissertation submitted in candidature for Membership of the Faculty of Occupational Medicine Correspondence and reprint requests to: Dr Stephen Simpson, Area Medical and Safety Adviser, Post Office, Charles House, 24 St Peters Street, Colchester CO1 IEP, UK

0 1989 Butterworth & Co (Publishers) Ltd 0268~0033/89/010064-01 $03.00

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which was marked at the centre, and at points 10 cm either side of the central mark; the length between the two extreme points was the measuring range.

Each subject was invited to attend for medical consul- tation, which comprised a full medical history and orthodox spinal examination. They were asked to stand in a comfortable position, looking straight ahead, with feet together and arms hanging loosely by the side. No support was allowed.

The lumbar lordosis was examined and the tlexicurve was applied to the lumbar spine in the mid-line so that the central mark overlay the apex of the lumbar curve. The flexicurve was then moulded to the spinal contour and the curve between the two extreme points traced onto graph paper. This was called the standing profile. The subject was then asked to bend backwards as far as he could without incurring pain. A further profile was then taken and this was called the extension profile. This was also transferred to graph paper. The tracings were studied and various measurements and angles were calculated.

It was found that the average standing and extension profiles were different in the two groups; subjects with low back pain had flat backs and restricted extension movements. These readings were not associated with age. Tall individuals were more likely to be low back pain sufferers.

These results suggested that the degree of lumbar lordosis was an important and previously under-rated clinical sign. As controversy surrounds the merits of many treatments for low back pain, any addition to the range of objective measuring devices is of value.