People with chronic low back pain may see a physiotherapist for treatment. The therapist uses tests of movement and strength to find out what's wrong. Changing the position of the spine is one way to help reduce painful symptoms.

The therapists in this study looked at 14 different tests of trunk and limb movements. They measured the change in patient symptoms as being better, worse, or the same after each test. The goal was to find positions or directions of movement that improved symptoms. Therapists can use this information to teach patients better ways to move at home, work, and play.

Bending forward in the standing position was the test most likely to increase symptoms. Getting down on hands and knees (quadruped position) was the most comfortable. Rocking back in the quadruped position was even more likely to bring relief from low back pain.

The authors of this study also report that moving the arms and legs while keeping the trunk still can make symptoms worse. For example, lifting a leg up while lying on the back tended to cause complaints of back and leg pain. Some patients also had increased back pain when lying face down and bending the knee or turning the hip in or out.

Finding positions of comfort allows patients with chronic low back pain to safely increase their movement. Therapists help their patients find these positions and use them when they sit, stand, and move in everyday activities. The results of this study help therapists know which tests to use with each back pain patient. Finding positions and movements that are comfortable may help speed up the recovery and rehabilitation process.

Linda R. Van Dillen, PhD, PT, et al. The Effect of Modifying Patient-Preferred Spinal Movements and Alignment During Symptom Testing in Patients With Low Back Pain: A Preliminary Report. In Archives of Physical Medicine and Rehabilitation. March 2003. Vol. 84. No. 3. Pp. 313-322.