Alister du Rose

Conflicts of interest: ‘No conflicts of interest’ Sources of funding: ‘No funding obtained’ Background: Intervertebral motion is a key component of spinal biomechanics and plays a central role in understanding lumbar function, pain generation, and clinical decision-making. Numerous techniques have been developed to measure and interpret in vivo lumbar intervertebral motion, each offering unique strengths and constraints. Despite this diversity, the field lacks a unified taxonomy that clearly differentiates study types and methodological approaches. This scoping review sought to map, characterise and organise the range of study designs used to investigate lumbar intervertebral motion in living subjects. Methods and Results: A scoping review was conducted using the Arksey and O'Malley (2005) framework and reported in accordance with PRISMA-ScR guidelines. Studies were eligible if they were published in English, involved living human participants, and used objective methods to capture motion sequences of the lumbar spine. Comprehensive searches of PubMed, CINAHL and SCOPUS were undertaken for publications from January 2000 to October 2025. After duplicate removal, titles and abstracts were screened, followed by full-text assessment. Data were charted under predefined headings capturing study purpose, technology, participant characteristics, measurement approach, interpretive methods, radiation exposure and key findings. Forty-nine studies met inclusion criteria. These were grouped into 11 study types, forming six overarching categories: normal biomechanical mechanisms, pathological or injury mechanisms, direct kinematic measurement, spinal stabilisation, dynamic radiography and clinical markers. Conclusion: This review provides a structured taxonomy that clarifies the methodological landscape of lumbar intervertebral motion research. The framework offers researchers, clinicians and policymakers a coherent reference to support study design, enhance comparability and promote greater standardisation across the field. The paper has just recently been published: Breen, A., Breen, A., Branney, J., du Rose, A., & Nematimoez, M. (2026). Advances in the Measurement and Interpretation of Intervertebral Motion in the Lumbar Spine: A Scoping Review. Bioengineering, 13 (2), 239. https://doi.org/10.3390/bioengineering13020239

Conflicts of interest: The research was conducted by York Health economics Forum at the request of the British chiropractic Association (BCA). Some colleagues within the authorship are BCA members. Sources of funding: The research was funded by the British Chiropractic Association (BCA). Introduction: Musculoskeletal (MSK) disorders are a major contributor to lost productivity in the UK, accounting for 30 million missed workdays yearly. Demand on NHS MSK services continues to rise, reflected in physiotherapy waiting times that average 11 weeks. Although chiropractors are internationally recognised as qualified MSK clinicians, they are not currently incorporated into NHS pathways, despite having the capacity to provide rapid access to care. This study set out to examine how chiropractic care influences return-to-work outcomes relative to usual care and to model the potential economic impact of involving chiropractors in mitigating NHS physiotherapy backlogs. Methods and Results: A structured, pragmatic review of MEDLINE and CINAHL produced 1,270 papers, of which 18 satisfied the inclusion criteria. Survey findings were used to estimate available chiropractic capacity, and NHS dataset review provided insight into national waiting times. Economic modelling, including Markov-based approaches, was used to estimate productivity gains associated with shortened delays in returning to work. The evidence indicates that chiropractors achieve return-to-work outcomes comparable to physiotherapists and osteopaths. Chiropractors' unused capacity could accommodate 114,000 additional patients per year, equivalent to 7–12% of present waiting lists and potentially generate £1.07 billion in productivity gains. With chiropractic wait times averaging 1.5 weeks versus 11 weeks for physiotherapy, substantial benefits emerge. Estimated annual productivity gains are £612 million for 11-week waits, rising to £1.46 billion for 24-week delays. Conclusion: Bringing chiropractors into NHS MSK pathways could shorten waiting times, increase workforce participation, and deliver meaningful economic benefits. Their integration represents a cost-efficient response to national MSK service pressures. The findings have been previously published and disseminated: World Federation of Chiropractors Conference, Copenhagen, 7–10th May 2025.

Background: Intervertebral motion is a fundamental aspect of spinal biomechanics, crucial for understanding lumbar spine function, pain mechanisms, and surgical outcomes. Various methods exist for measuring and interpreting it, each with its own advantages, limitations, and specific applications. However, a comprehensive and standard taxonomy of study types for the measurement and interpretation of in vivo intervertebral motion in the lumbar spine is lacking. Objectives: This review aimed to systematically identify, characterise, and categorise the diverse study types deposited in the literature. Eligibility criteria: Only studies in English and of lumbar spine intervertebral motion in living subjects were considered, and only those that employed objective measurement of motion sequences were included. Sources of evidence: A comprehensive literature search was performed in PubMed, CINAHL, and SCOPUS for articles published between January 2000 and October 2025. Charting methods: After removal of duplicates, all studies were subjected to Title and abstract screening, followed by full-text screening of potentially eligible studies. Data selected were charted into tables under the headings: author, year, country, purpose, technology, participants, measurement, interpretation, radiation dosage, and significance of findings. Results: Forty-nine studies were abstracted and are described under 11 study types. These formed a taxonomy constituting the following six categories: normal biomechanical mechanisms, pathological and injury mechanisms, direct kinematic measurement, spinal stabilisation, dynamic radiography, and clinical markers. The resulting taxonomy will serve as a resource for researchers, clinicians, and policymakers by facilitating a more coherent understanding of the field and promoting standardisation in research design and reporting.

Background/Objectives: The assessment of relationships between trunk muscle activity and thoraco-lumbar movements during sagittal bending has demonstrated that low back pain (LBP) subgroups (flexion pattern and active extension pattern motor control impairment) reveal distinct relationships that differentiate these subgroups from control groups. The study objective was to establish whether such relationships exist during various daily activities. Methods: Fifty participants with non-specific chronic low back pain (NSCLBP) (27 flexion pattern (FP), 23 active extension pattern (AEP)) and 28 healthy controls were recruited. Spinal kinematics were analysed using 3D motion analysis (Vicon™, Oxford, UK) and the muscle activity recorded via surface electromyography during a range of activities (box lift, box replace, reach up, step up, step down, stand-to-sit, and sit-to-stand). The mean sagittal angles for upper and lower thoracic and lumbar regions were correlated with normalised mean amplitude electromyography of bilateral transversus abdominis/internal oblique (IO), external oblique (EO), superficial lumbar multifidus (LM), and erector spinae (ES). Relationships were assessed via Pearson correlations (significance p < 0.01). Results: In the AEP group, increased spinal extension was associated with altered LM activity during box-replace, reach-up, step-up, and step-down tasks. In the FP group, increased lower lumbar spinal flexion was associated with reduced muscle activation, while increased lower thoracic flexion was associated with increased muscle activation. The control group elicited no significant associations. Correlations ranged between −0.812 and 0.754. Conclusions: Differential relationships between muscle activity and spinal kinematics exist in AEP, FP, and pain-free control groups, reinforcing previous observations that flexion or extension-related LBP involves distinct motor control strategies during different activities. These insights could inform targeted intervention approaches, such as movement-based interventions and wearable technologies, for these groups.

Study purpose and background: Kinematic variables have been identified as potential biomarkers for low back pain patients; however, an in-depth comparison between chronic (n=22), acute (n=15), and healthy controls (n=136) has not been done. This retrospective data analysis compared intervertebral lumbar motion parameters, angular range of motion, translation, maximum disc height, motion share inequality (MSI) and variability (MSV), and laxity, between these groups.Methods and results: Kinematic parameters were determined using video tracking techniques utilising quantitative fluoroscopy (QF), during both weight-bearing and recumbent controlled sagittal bending tasks. Data was analysed for normality, and appropriate statistical tests were applied to determine differences between groups. There were no significant differences between the groups for age, height, weight and sex. Whilst few differences were found between acute and healthy groups, differences were shown between both chronic and healthy, and acute and chronic groups for all six parameters. Of particular note were examples of differences in the motion share parameters between the acute and chronic populations, with an increased MSI in the chronic group during recumbent flexion, and MSV during recumbent extension, and inversely an increase in MSV in the acute group during weight-bearing flexion.Conclusion: Analysis of intervertebral lumbar motion provides valuable insights into kinematic differences between chronic, acute, and healthy control populations. These findings suggest that there is variation between the groups which is knowledge that may benefit management strategies. Further exploration of the time varying data is warranted to explore how such differences may relate to the motion share inequalities and variability shown.Conflicts of Interest: No conflicts of interestSources of Funding: No funding obtained

While neck pain can be defined in clinical terms, in most cases the underlying pathophysiology is largely unknown. Regional cervical spine range of motion is often found to be reduced in patients with neck pain compared to persons without pain although it is not clear if the decreased range is cause or effect. Less is known about the role of intervertebral kinematics and how that might be related to the presence of disc degeneration. In this study, the prevalence of intervertebral disc degeneration and continuous cervical intervertebral motion were both measured utilizing quantitative fluoroscopy (QF) in patients with subacute or chronic neck pain (n = 29) and gender-matched healthy controls (n = 30). A composite disc degeneration (CDD) score was calculated for each participant from the first, neutral, lateral fluoroscopic image. Intervertebral motion sharing parameters of motion-sharing inequality (MSI) and motion-sharing variability (MSV) were derived from the active cervical motion sequences obtained while patients were seated. The objective was to determine if average age, CDD, MSI, and MSV values were correlated and if there were differences in these variables between the neck pain group and the healthy control group. Correlation analysis was conducted for age, CDD, MSI, and MSV in each group. Age was moderately correlated with MSV in cervical spine extension in patients only (r = 0.63, p < 0.001). There were no significant differences in the prevalence of disc degeneration (CDD) between patients, who had on average mild pain and related disability, and healthy controls (median CDD 2 both groups, p = 0.94). There were also no significant differences in either flexion or extension intervertebral motion-sharing inequality or variability (MSI or MSV) between groups as measured during active cervical motion.

Background: Chiropractors use a treatment strategy called maintenance care with the intent of secondary and tertiary prevention. The Nordic Maintenance Care Program provides evidence of when and for whom maintenance care should be offered. Dissemination has occurred through articles, workshops, social media, conference in Europe and internationally. However, little is known about chiropractors’ awareness and use of this evidence. This study explores chiropractors’ attitudes, skills, and use of evidence on maintenance care, as well as study their association with general evidence-based practice and demographic characteristics. Moreover, barriers and facilitators of evidence access are also examined. Methods: Questions pertaining our research aim were included in the anonymous and digital Evidence-Based practice Attitude and utilization SurvEy, which was distributed to all members (n = 770) of the Norwegian chiropractic association in the fall of 2021. Results: The response rate was 41% (n = 312). Regarding attitudes towards evidence-based maintenance care, 26% agreed they needed tools to recommend this care to patients. Approximately half (57%) believed they had skills to identify suitable patients, and 45% had used published information in the past month. Strong alignment was observed between Norwegian chiropractors’ attitudes, skills, and utilization of evidence-based maintenance care and general evidence-based practice. Maintenance care skills were significantly associated with age (those between 40 and 59 years being less likely to report having high skills), clinical setting (those working with conventional health care providers being less likely to report having high skills) and country of education (those educated in the US and Australia being more likely to report having high skills). Moreover, maintenance care use was significantly associated with country of education (those educated in Australia were less likely to have used published information regarding patient selection for maintenance care). Access to resources was a barrier, whereas knowledge of patient suitability facilitated evidence-based maintenance care. Conclusions: Norwegian chiropractors had neutral attitudes towards maintenance care, but generally reported moderate skills. Most had not used evidence about maintenance care in the previous month. Access to useful resources about the evidence regarding maintenance care was a barrier, and knowledge of who responds to maintenance care was a facilitator.

Objective: Pathoanatomical beliefs about the cause of low back pain may negatively influence patients' perceptions of ‘best care’, such as the inclusion of exercise for low back pain (LBP) management. The aims of this study were to explore what patients receiving manual therapy are told and understand about their LBP diagnosis, and how this affects their perceptions regarding the role of exercise in the management of their LBP.Design: An interpretative phenomenological analysis (IPA) study design was utilised using semi‐structured telephone interviews of patients who experience persistent LBP and seek care at an outpatient clinic at the University of South Wales. Ten participants were interviewed for the study (six male). Interviews were transcribed verbatim and analysed using an IPA approach.Results: Three main themes were generated: (1) Constructing explanation of pain. (2) Expectations of exercise within care seeking behaviours. (3) Resolving conflict between exercise and back pain narratives. Participants linked their pain to a pathoanatomical cause, impacting their beliefs on exercise as a treatment approach.Conclusion: Diagnostic models used by clinicians which are grounded within a pathoanatomical framework influence patients' perceptions and rationale for exercise. Exercise prescription using contemporary pain science and biopsychosocial approaches should be emphasised in practice and education.