Do Muscle Strength Imbalances and Low Flexibility Levels Lead to Low Back Pain? A Brief Review

Chronic low back pain (CLBP) has been related to hips, trunk and spine strength imbalances and/or low flexibility levels. However, it is not clear if the assessment and normalization of these variables are effective for prevention of low back pain (LBP) episodes and rehabilitation of patients with CLBP. This brief review explored studies that have associated hip, trunk and spine strength imbalances and/or low flexibility levels to LBP episodes or CLBP condition. Fourteen studies were selected by accessing PubMed and Google Scholar databases. Collectively, the selected studies demonstrate that trunk eccentric/concentric and flexion/extension strength imbalances may be associated with CLBP or LBP episodes. However, the literature fails to demonstrate any clear relationship between hip strength imbalances or low levels of spine flexibility with CLBP or LBP episodes. In addition, there is no direct evidence to support the idea that the normalization of these variables due to resistance and flexibility training leads to pain reduction and functionality improvements in subjects with CLBP. Although further investigation is needed, the lack of a clear direct association between hip strength imbalances or spine low flexibility levels to CLBP or LBP episodes may demonstrate that these variables may have very low effect within the complexity of these conditions.