The causes of low back pain (LBP) appear to be complex and multifactorial, with both biological and psychosocial components associated with chronicity [1, 2]. While numerous patho-anatomic structures have been associated with LBP, it is often difficult to establish a definitive anatomical cause or initiating factor for LBP in individual people [3, 4]. Furthermore, although the pathogenesis of LBP has also been associated with genetic causes , such influences are not readily modifiable. In daily practice, many clinicians observe and treat physical impairments ranging from postural anomalies [6, 7], localised intervertebral kinetic disturbance , motor control disturbance [9, 10], muscle imbalance  and muscle atrophy .
People with persistent (chronic) or recurrent LBP have been variably reported to exhibit movement pattern aberrations such as increased trunk stiffness [9, 13], poor proprioception , altered patterns of activation of abdominal muscles [10, 15], extensor muscles [16–18], and postural dysfunction [19–21]. Different patterns of lumbo-pelvic kinematics during activities such as forward bending and sit-to-stand have been demonstrated in studies comparing people with and without LBP [22–25]. Methods for measuring lumbo-pelvic movement patterns can by categorised into three broad target groups: (i) muscle activity patterns, for example the contribution of deep versus superficial trunk muscles, (ii) patterns of hip to lumbar kinematics, for example the relative contributions of hip joint compared with lumbar spine movement to specific activities such as forward bending or walking, and (iii) postural patterns, for example slumped sitting compared with upright sitting posture.
Numerous interventions have targeted movement pattern aberrations associated with chronic LBP [10, 26–29]. Some exercise interventions involve whole body movements such as aerobic exercise, Pilates, and yoga, while others target the activity of specific muscles. The effectiveness of exercise for LBP appears modest and not consistently associated with any particular form of exercise [30–32]. No consistent differences in LBP outcomes have been observed for highly individualised exercise programs that aim to alter lumbo-pelvic kinematics or postural patterns such as those based on the Alexander Technique [33, 34], the Feldenkrais Method  or Pilates  compared with non-specific exercise. Similarly, reviews of interventions designed to alter patterns of specific muscle activity, variably described as motor control, trunk stabilisation or core stabilising exercise, have concluded little difference between outcomes achieved with motor control exercise compared with general exercise regimens [36–40]. As there is no standardisation in the reporting of exercise type, intensity, duration or frequency, one possibility is that some exercises are effective, but when trial outcomes are pooled, method heterogeneity in included studies precludes identification of trial-specific effectiveness.
Movement pattern aberrations associated with LBP, such as deviation from the normal activation patterns of Transversus Abdominus (TA) [10, 41] have been reported. However the effect of interventions on these aberrant movement deficits has not been systematically evaluated. While most trials report effects on pain or activity limitation, few have measured changes in movement or postural patterns. This is reflected in five recent systematic reviews on the effectiveness of stabilisation (‘motor control’) exercises for LBP [36–40], which collectively synthesised 26 randomised controlled trials. More than half of the included trials in these reviews [36–40] used outcome measures of pain and activity limitation without measurement of any movement characteristic. Only three of 26 trials measured the effect of the intervention on a specific movement pattern aberration. As few trials measure movement pattern aberrations, this leaves three fundamental questions unanswered by existing reviews: (i) were movement pattern aberrations actually present in trial participants who received interventions designed to remedy these deficits? (ii) did the intervention achieve the intention of changing the movement pattern? and (iii) were improvements in other health parameters such as pain and activity limitation related to changes in movements classified as aberrant? To understand whether treatment can change movement pattern aberration, measurement of such deficits should occur before and after treatment, and the outcomes compared with those of a control group.
Aims of this review
The first aim of this systematic review was to determine the effect of movement-based interventions on movement patterns defined as physical measures of muscle activation, lumbo-pelvic kinematics or postural patterns in adults with LBP. The second aim was to examine the relationship between changes in movement patterns and subsequent changes in pain and activity limitation.