Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability.

There is growing evidence for the idea that in back pain patients, pain-related fear (fear of pain/physical activity/(re)injury) may be more disabling than pain itself. A number of questionnaires have been developed to quantify pain-related fears, including the Fear-Avoidance Beliefs Questionnaire (FABQ), the Tampa Scale for Kinesiophobia (TSK), and the Pain Anxiety Symptoms Scale (PASS). A total of 104 patients, presenting to a rehabilitation center or a comprehensive pain clinic with chronic low back pain were studied in three independent studies aimed at (1) replicating that pain-related fear is more disabling than pain itself (2) investigating the association between pain-related fear and poor behavioral performance and (3) investigating whether pain-related fear measures are better predictors of disability and behavioral performance than measures of general negative affect or general negative pain beliefs (e.g. pain catastrophizing). All three studies showed similar results. Highest correlations were found among the pain-related fear measures and measures of self-reported disability and behavioral performance. Even when controlling for sociodemographics, multiple regression analyses revealed that the subscales of the FABQ and the TSK were superior in predicting self-reported disability and poor behavioral performance. The PASS appeared more strongly associated with pain catastrophizing and negative affect, and was less predictive of pain disability and behavioral performance. Implications for chronic back pain assessment, prevention and treatment are discussed.

Plasma atrial natriuretic peptide and cyclic nucleotide levels before and after a marathon.

Plasma alpha-atrial natriuretic peptide (alpha-ANP) concentration and levels of cyclic nucleotides [guanosine 3',5'-cyclic monophosphate (cGMP) and adenosine 3',5'-cyclic monophosphate (cAMP)] were studied in 23 runners before and after a marathon race. Blood samples were drawn from an antecubital vein the morning before the race (base line), at 3 P.M. (i.e., 2 h before the start), on arrival, and 12 and 36 h and 7 days later. Compared with the base-line values of plasma alpha-ANP (5 pmol/l), cGMP (3.8 nmol/l), and cAMP (15.8 nmol/l), the plasma levels of alpha-ANP, cGMP, and cAMP were increased immediately after the marathon, respectively, to 12.0 pmol/l, 12.7 nmol/l, and 50.5 nmol/l. The increase in the plasma alpha-ANP concentration was related (r = 0.85; P less than 0.001) to the changes in plasma cGMP, plasma lactate, hematocrit, and body weight. The plasma cGMP and cAMP concentrations had returned to the prerace levels 12 h after the marathon, whereas the plasma alpha-ANP concentration was significantly lower (3.1 pmol/l) than the base-line values and increased above the prerace values 36 h (7.5 pmol/l) and 7 days (6.8 pmol/l) after the marathon. The plasma cGMP level was also higher 36 h (5.4 nmol/l) and 7 days (5.0 nmol/l) after the marathon race.

Pelvi-perineal rehabilitation for dysfunctioning erections. A clinical and anatomo-physiologic study.

We have studied penile structure in 24 cadaver specimens and 155 patients have been treated for organic impotence by physiotherapy. Special attention has been focused on the closure mechanism of the corpora cavernosa during erection. We have found that the leakage factor of the corpora cavernosa is, among other things, influenced by the ischiocavernous muscles. Based on the above, we propose a model for the anatomic and physiologic basis of interference of the ischiocavernous muscles in venous occlusion during penile erection. Moreover we suggest that patients with erectile dysfunction should undergo pelvi-perineal rehabilitation in order to strengthen and control ischiocavernous muscles.

Long-term fluctuations of pressure pain thresholds in healthy men, normally menstruating women and oral contraceptive users.

The aim of this investigation was to evaluate whether the pressure pain threshold (PPT) in masticatory muscles of symptom-free subjects was influenced by fluctuations of the sex hormones. The PPT was measured with an electronic algometer for at least 10 consecutive menstrual cycles in 10 women using oral contraceptives and 10 women not using oral contraceptives, with a regular menstrual cycle (26-31 days). In addition, 10 men were measured in a regular pattern over a period of 1 year. All subjects were symptom-free with an age range between 18 and 39 years. Measurement sessions were held during three different cycle phases (follicular, luteal, perimenstrual) and each session consisted of four consecutive PPT measurements. By means of a linear mixed model (SAS), the PPTs of the masster, temporalis and thumb muscles were compared between: (1) groups, (2) sex-hormonal phases, (3) the four consecutive measurements of each muscle per session and (4) time. The PPTs of the masseter (p = 0.8419) and temporalis muscles (p = 0.2786) did not change significantly over time. There was no significant difference in variance for the masseter (p = 0.6250), temporalis (p = 0.9705) and thumb (p = 0.7446) between the three groups. The PPTs of all muscles were significantly lower during the perimenstrual phases in the two female groups. The present data showed similar patterns of PPTs for the three muscle groups. Moreover, the results have shown a very good consistency of the PPTs over a long time period, both in males and females.

Wheelchair propulsion efficiency: movement pattern adaptations to speed changes.

Low mechanical efficiency values in wheelchair propulsion are usually explained on the basis of the supply of force and power generated during the push phase. The purpose of this study is to analyze the movement and muscular activity pattern in handrim wheelchair propulsion, focusing on both the push and recovery phases. Data on cardiorespiratory and propulsion technique parameters were obtained from 40 wheelchair basketball players with extensive experience in wheelchair propulsion in six situations: two exercise levels (60% and 80% of individual VO2peak), and three velocities (1.11, 1.67, and 2.22 m.s-1) with constant power output on a treadmill. A two-factor analysis of variance with repeated measurements was applied with "exercise level" and "speed" as the main factors. A significant effect on gross mechanical efficiency was found when the velocity was increased from 1.67 to 2.22 m.s-1. Decreased mechanical efficiency could be explained by a significant change in the acceleration of the wheelchair-user system during recovery, caused by arm and trunk movements, inducing inertial forces to act on the wheelchair. Consequently, mechanical work increased significantly during the recovery phase. These findings indicate that studies on mechanical efficiency in wheelchair propulsion should not only be focussed on power supply during the push phase, but also on the movement pattern during recovery.

No effect of glycogen level on glycogen metabolism during high intensity exercise.

This study examined the effect of glycogen supercompensation on glycogen breakdown, muscle and blood lactate accumulation, blood-pH, and performance during short-term high-intensity exercise. Young healthy volunteers performed two supramaximal (125% of VO2max) exercise tests on a bicycle ergometer, either for 1 min 45 s (protocol 1; N = 18) or to exhaustion (protocol 2; N = 14). The exercise tests were preceded by either 5 d on a controlled normal (N) diet, or by 2 d of glycogen-depleting exercise accompanied by the normal diet followed by 3 d on a carbohydrate-rich (CHR) diet. In protocol 1, preexercise muscle glycogen concentrations were 364 +/- 23 and 568 +/- 35 mumol.g-1 d.w. in the N and CHR condition, respectively (P < 0.05). During the exertion, glycogen concentration in the M. quadriceps decreased to the same extent in both groups. Accordingly, the exercise-induced increases in muscle and blood-lactate, and the fall in blood-pH were similar during N and CHR. In protocol 2, time to exhaustion was identical for N and CHR. It is concluded that during short-term intense exercise during which muscle glycogen availability exceeds glycogen demand, rate of glycogen breakdown, lactate accumulation, and performance are regulated irrespective of the preexercise muscle glycogen level.

Inheritance of physical fitness in 10-yr-old twins and their parents.

This study focuses on the quantification of genetic and environmental sources of variation in physical fitness components in 105 10-yr-old twin pairs and their parents. Nine motor tests and six skinfold measures were administered. Motor tests can be divided into those that are performance-related: static strength, explosive strength, running speed, speed of limb movement, and balance; and those that are health-related: trunk strength, functional strength, maximum oxygen uptake, and flexibility. The significance and contribution of genetic and environmental factors to variation in physical fitness were tested with model fitting. Performance-related fitness characteristics were moderately to highly heritable. The heritability estimates were slightly higher for health-related fitness characteristics. For most variables a simple model including genetic and specific environmental factors fitted the observed phenotypic variance well. Common environmental factors explained a significant part of the variation in speed components and flexibility. Assortative mating was significant and positive for speed components, balance, trunk strength, and cardiorespiratory fitness, but negative for adiposity. Static strength, explosive strength, functional strength, and cardiorespiratory fitness showed evidence for reduced genetic transmission or dominance. The hypothesis that performance-related fitness characteristics are more determined by genetic factors than health-related fitness was not supported. At this prepubertal age, genetic factors have the predominant effect on fitness.

Bone mass and lifetime physical activity in Flemish males: a 27-year follow-up study.

PURPOSE: The present population study is conducted to examine the extent to which lifetime physical activity and lifestyle parameters contribute to bone mass. METHODS: The design of the project is a 27-yr prospective follow-up study. Subjects are 126 males gathered from the Leuven Longitudinal Study on Lifestyle, Physical Fitness and Health, and aged 13 yr at the onset of the study and 40 at the end of the follow-up. Physical activity and lifestyle parameters are obtained with questionnaires. Bone mass is measured by means of dual-energy x-ray absorptiometry (DXA). RESULTS: Results from correlation and regression analyses show that the body mass index (BMI) is the most important parameter in relation to cortical and trabecular bone mass at every examination period. Longitudinally, static arm strength, running speed, and upper muscular endurance contribute significantly to the prediction of adult bone mass. The parameter "change in motor fitness" between 18 and 13 yr old was used to control for hereditary influences. The score for static arm strength and trunk muscle strength demonstrates a significant correlation with adult total bone mineral content (BMC) and lumbar bone mineral density (BMD), respectively. At the age of 40, the Baecke sports index is almost equally important as BMI in explaining the variance in BMD, and static arm strength is the most important parameter (after BMI) for BMC. CONCLUSION: Lifetime physical activity, physical fitness, and BMI all contribute to adult bone mass. The clinical relevance of these findings is emphasized by the fact that the observed patterns of physical activity and motor fitness pertain to customary lifestyle and are thus feasible targets.

Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship?

OBJECTIVE: In a former study, we have shown that patients suffering from chronic fatigue syndrome (CFS) or chronic pain, when questioned about their premorbid lifestyle, reported a high level of "action-proneness" as compared to control groups. The aim of the present study was to control for the patients' possible idealisation of their previous attitude towards action. METHODS: A validated Dutch self-report questionnaire measuring "action-proneness" (the HAB) was completed by 62 randomly selected tertiary care CFS and fibromyalgia (FM) patients, as well as by their significant others (SOs). RESULTS: HAB scores of the patients and those of the SOs were very similar and significantly higher than the norm values. Whether or not the SO showed sympathy for the patient's illness did not influence the results to a great extent. SOs with a negative attitude towards the illness even characterized the patients as more "action-prone." CONCLUSIONS: These results provide further support for the hypothesis that a high level of "action-proneness" may play a predisposing, initiating and/or perpetuating role in CFS and FM.

Do pain expectancies cause pain in chronic low back patients? A clinical investigation.

The present study investigated whether pain expectancies cause pain in chronic low back patients. Back patients (N = 29) were requested to perform four exercise bouts (two with each leg), each consisting of flexing and extending the knee three times at maximal force (Cybex 350 System). During each exercise bout the baseline pain, the expected pain and experienced pain were recorded. Patients also reported their experienced fear of further injury to the back. Furthermore, the peak force of both knee flexors and extensors was assessed. Although patients did expect a back pain increase during the first exercise bout with each leg, no evidence was found for the thesis that pain expectancies generate increases in subjective pain experiences. Instead, the reported pain expectancy was readily corrected during the next exercise bout, whereas the experienced pain remained unchanged. Furthermore, a high pain expectancy co-occurred with (1) a marginally significant fear of (re)injury, and (2) a significant lower peak torque of the knee flexors. These results are consistent with conditioning models which state that pain expectations are associated with a fear response and an urge to avoid the pain.

Orthotic devices for treating patellofemoral pain syndrome.

BACKGROUND: Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of the knee, active training devices, knee sleeves and in-shoe orthotics to support the foot have been advocated to treat this condition. OBJECTIVES: To assess the effectiveness of foot and knee orthotics for treatment of patellofemoral pain syndrome. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials register (Issue 2, 2000), MEDLINE (January 1966 to March 2000; EMBASE (January 1988 to March 2000); CINAHL (January 1982 to March 2000) and PEDro (up to March 2000). Relevant orthotic companies were contacted. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing the effectiveness of knee or foot orthotics for treatment of patellofemoral pain syndrome were selected. Trials describing the use of orthotic devices in conjunction with operative treatment were excluded. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed methodological quality of the identified trials by use of a modified version of the Cochrane Musculoskeletal Injuries Group assessment tool, consisting 11 items. Two reviewers extracted data without blinding. Trialists were contacted to obtain missing data. MAIN RESULTS: Five trials involving 362 participants were included in this review. Five other trials await possible inclusion if further information can be obtained and one awaits further assessment. Due to clinical heterogeneity, we refrained from statistical pooling and conducted analysis by grading the strength of scientific evidence. The level of obtained research-based evidence was graded as limited as all trials were of low methodological quality. This limited research-based evidence showed the Protonics orthosis at six week follow-up was significantly more effective for decrease in pain (weighted mean difference (WMD) between groups 3.2; 95% confidence interval (CI) 2.8 to 3.6), functional improvement on the Kujala score (WMD 45.6; 95% CI 43.4 to 47.7) and change in patellofemoral congruence angle (WMD 17.2; 95% CI 14.1 to 20.3) when compared to no treatment. A comprehensive programme including tape application was significantly superior to a monitored exercise programme without tape application for decrease in worst pain (WMD 1.6; 95% CI 0.4 to 2.8) and usual pain (WMD 1.2; 95% CI 0.2 to 2.1), and clinical change and functional improvement questionnaire scores (WMD 10, 95% CI 2.07 to 17.93) at four weeks follow-up. The trials reported statistically significant differences in patient satisfaction after applied therapy (WMD 3.3; 95% CI 0.5 to 6.1) in favour of the McConnell regimen compared with the Coumans bandage at six weeks follow-up. REVIEWER'S CONCLUSIONS: The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of knee and foot orthotics for the treatment of patellofemoral pain. Future high quality trials in this field are warranted.

Effect of paraspinal muscle vibration on position sense of the lumbosacral spine.

STUDY DESIGN: A two-group experimental design with repeated measures on one factor was used. OBJECTIVES: To investigate the role of the muscle spindles of the paraspinal muscles in lumbosacral position sense of healthy individuals. SUMMARY OF BACKGROUND DATA: Muscle spindles are recognized to be important mediators for position and movement sense in peripheral joints, and they are very sensitive to mechanical vibration. However, little is known about their role in the control of lumbosacral spine positioning. METHODS: Twenty-five young individuals with no low back pain were assigned at random to an experimental or control group. Proprioceptive information of the multifidus muscle spindles was distorted in half of the trials in 16 individuals by manually applying vibration (70 Hz, 0.5 mm amplitude) for approximately 5 seconds. The control group (n = 9) only heard the vibrator noise during repositioning of the lumbosacral spine. Repositioning accuracy in the sitting position was estimated by calculating the mean absolute error, constant error, and variable error among six criteria and reproduction sacral tilt angles. RESULTS: Multifidus muscle vibration induced a significant muscle lengthening illusion through which the members of the experimental group undershot the target position (F(1,15) = 30.77, P < 0.0001). The position sense scores of the control group displayed no significant differences across trials (F(1,8) = 0.56, P > 0.05). CONCLUSIONS: The findings suggest that precise muscle spindle input of the paraspinal muscles is essential for accurate positioning of the pelvis and lumbosacral spine in a sitting posture.

The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain.

STUDY DESIGN: A two-group experimental design with repeated measures on one factor was used. OBJECTIVES: To investigate the role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. SUMMARY OF BACKGROUND DATA: Proprioceptive deficits have been identified in patients with low back pain. The underlying mechanisms, however, are not well documented. METHODS: Lumbosacral position sense was determined before, during, and after lumbar paraspinal muscle vibration in 23 young patients with low back pain and in 21 control subjects. Position sense was estimated by calculating the mean absolute error, constant error, and variable error between six criterion and reproduction sacral tilt angles. RESULTS: Repositioning accuracy was significantly lower in the patient group than in healthy individuals (absolute error difference between groups = 2.7 degrees, P < 0.0001). Multifidus muscle vibration induced a significant muscle-lengthening illusion that resulted in an undershooting of the target position in healthy individuals (constant error = -3.1 degrees, P < 0.0001). Conversely, the position sense scores of the patient group did not display an increase in negative directional error but a significant improvement in position sense during muscle vibration (P < 0.05). No significant differences in absolute error were found between the first and last trial in the healthy individuals (P >/= 0.05) and in the patient group (P > 0.05). CONCLUSIONS: Patients with low back pain have a less refined position sense than healthy individuals, possibly because of an altered paraspinal muscle spindle afference and central processing of this sensory input. Furthermore, muscle vibration can be an interesting expedient for improving proprioception and enhancing local muscle control.

Septic arthritis of a lumbar facet joint caused by Staphylococcus aureus.

STUDY DESIGN: Case report of a 35-year-old woman with septic arthritis of a lumbar facet joint. OBJECTIVES: To report a rare case of severe low back pain and the specific differential diagnostic problems. SUMMARY OF BACKGROUND DATA: Differential diagnosis between spondylodiscitis and facet joint septic arthritis on a clinical basis is very difficult. The lesions of the joint appear on a plain film only approximately 1.5 months after onset of the symptoms. Although the radionuclide bone scan is sensitive and shows a more laterally and vertically localized uptake than in spondylodiscitis, this technique is not very specific. Computed tomography scan and magnetic resonance imaging are the most reliable investigations even at the very early stages of the disease. Confirmation of the diagnosis has to be obtained by blood cultures or, in exceptional cases, by direct puncture of the joint. Appropriate antibiotic treatment is in most cases sufficient to heal this lesion. METHODS: The etiology, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Computed tomography scan and magnetic resonance imaging complemented by positive blood cultures led to the very early diagnosis of septic arthritis of the lumbar facet joint in this relatively young patient. CONCLUSIONS: With our case report we confirm the very small number of data reported in the literature, indicating that infections of the facet joint can be detected at a very early stage using magnetic resonance imaging and computed tomography scan.

Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study.

Many variables have retrospectively been associated with the presence of anterior knee pain. Very few prospective data exist, however, to determine which of these variables will lead to the development of anterior knee pain. It was our purpose in this study to determine the intrinsic risk factors for the development of anterior knee pain in an athletic population over a 2-year period. Before the start of training, 282 male and female students enrolled in physical education classes were evaluated for anthropometric variables, motor performance, general joint laxity, lower leg alignment characteristics, muscle length and strength, static and dynamic patellofemoral characteristics, and psychological parameters. During this 2-year follow-up study, 24 of the 282 students developed patellofemoral pain. Statistical analyses revealed a significant difference between those subjects who developed patellofemoral pain and those who did not concerning quadriceps and gastrocnemius muscle flexibility, explosive strength, thumb-forearm mobility, reflex response time of the vastus medialis obliquus and vastus lateralis muscles, and the psychological parameter of seeking social support. However, only a shortened quadriceps muscle, an altered vastus medialis obliquus muscle reflex response time, a decreased explosive strength, and a hypermobile patella had a significant correlation with the incidence of patellofemoral pain. We concluded that the latter four parameters play a dominant role in the genesis of anterior knee pain and we therefore deem them to be risk factors for this syndrome.

Open versus closed kinetic chain exercises for patellofemoral pain. A prospective, randomized study.

The goal of this prospective study was to evaluate the efficacy of open versus closed kinetic chain exercises in the nonoperative management of patellofemoral pain. Sixty patients were randomized into a 5-week program that consisted of only closed kinetic chain exercises or only open kinetic chain exercises. Muscle characteristics, subjective symptoms, and functional performance were evaluated in this study at the time of the initial physical examination, at the end of the treatment period, and 3 months later. Both groups experienced a statistically significant decrease in pain and an increase in functional performance. This study shows that both open and closed kinetic chain exercise programs lead to an improved subjective and clinical outcome in patients with anterior knee pain. The few significantly better functional results for some of the tested parameters in the closed kinetic chain group suggest that this type of treatment is a little more effective than the open kinetic chain program in the treatment of these patients.

Intrinsic risk factors for the development of patellar tendinitis in an athletic population. A two-year prospective study.

Retrospective studies have suggested various factors that might cause a disposition to develop patellar tendinitis, but no prospective data exist to determine any relationships. The purpose of this study was to determine the intrinsic risk factors for the development of patellar tendinitis in an athletic population. Before the study, 138 male and female students of physical education were evaluated for anthropometric variables, leg alignment characteristics, and muscle tightness and strength parameters. During the 2-year study, 19 of the 138 students developed patellar tendinitis. In all cases the diagnosis was confirmed by the presence of a hypoechogenic nodular lesion in the proximal region of the patellar tendon. Univariate and stepwise discriminant function analyses were performed comparing the various measurements. These analyses revealed that the only significant determining factor was muscular flexibility, with the patellar tendinitis patients being less flexible in the quadriceps and hamstring muscles (P < 0.05). The results of this study demonstrate that lower flexibility of the quadriceps and hamstring muscles may contribute to the development of patellar tendinitis in an athletic population. Therefore, the prevention of this condition in athletes should be focused on screening for and treating poor quadriceps and hamstring muscle flexibility.

The accident-prone and overuse-prone profiles of the young athlete.

A 1 year prospective study was done to develop an accident-prone and overuse-prone profile of young athletes. A group of 185 freshman physical education students (118 males; 67 females of the same age (18.3 +/- 0.5 years) trained under the same conditions and were exposed to similar extrinsic risk factors. Using a descriptive statistical technique, an analysis of correspondence, the complex interrelation between the criterium variables (acute injuries and overuse injuries) and the predictor variables (intrinsic risk factors; physical characteristics--anthropometric data, physical fitness parameters, flexibility aspects and malalignment of the lower extremities; and psychological factors--16 personality traits) was estimated for males and females separately. Although dynamic strength seems to be an important risk factor in acute injuries, sports accidents must be seen in relation to psychological factors. However, the overuse-prone profile is mainly based on physical traits: a combination of muscle weakness, ligamentous laxity, and muscle tightness predisposes to stress injuries. In addition, these overuse effects are intensified by large body weight and length, a high explosive strength, and malalignment of the lower limbs. Nevertheless, it has to be kept in mind that psychosomatic factors play a role in how one experiences these overuse phenomena.

Short-term reproducibility of pressure pain thresholds in masticatory muscles measured with a new algometer.

The purpose of this project was to test the within-day and between-days reproducibility of a new and inexpensive algometer. Twelve symptom-free men and nine women participated. Pressure pain thresholds (PPTs) of the bilateral masseter and temporalis muscles were assessed during four sessions (mornings and afternoons of days 1 and 3). During each session, each palpation point of the masticatory muscles was measured four times. There was an interval of only a few seconds between measurements 1 and 2, and between measurements 3 and 4, respectively, while at least 5 minutes of rest were allowed between measurements 2 and 3. The PPT values between the morning and afternoon sessions and between days 1 and 3 were not significantly different. When the within-session reproducibility for all muscles was considered, only the PPT values between measurements 2 and 4 were not significantly different. Analysis of variance showed that the interindividual variability of PPT was 1.4 to 6.8 times higher than the variability observed within or between sessions and days. No gender difference was found.

Lumbosacral repositioning accuracy in standing posture: a combined electrogoniometric and videographic evaluation.

OBJECTIVE: To provide a new method of measuring repositioning accuracy in the lumbosacral spine in a standing position. DESIGN: A test-retest and parallel-forms reliability testing was performed. BACKGROUND: The contribution of proprioception to lumbar muscle function and to the stability of the lumbar spine is relatively unknown. METHOD: A piezoresistive electrogoniometer attached to the skin over the sacrum and a three-dimensional video analysis system with reflective markers on anatomical landmarks were both employed to measure the repositioning accuracy of pelvic tilting in standing. Eleven subjects without low back pain participated in this study. RESULTS: The overall mean repositioning accuracy was 1.87 degrees. Probability values from repeated measures ANOVA revealed no significant mean absolute error (AE) differences between sessions. Correlation coefficients between electrogoniometer and 3-D video analysis measurements of position sense ranged from 0.84 to 0.97. CONCLUSIONS: The proposed instruments and method are adequate for measuring lumbosacral repositioning accuracy. Healthy subjects are capable of repositioning their pelvis and back precisely. RELEVANCE: A reliable method assessing the lumbosacral repositioning accuracy can add insight into neuromuscular dysfunction as a cause of mechanical low back pain.