Low back pain (LBP) is a common musculoskeletal problem that not only causes physical morbidity as well as socio-economic loss in the community. The lifetime incidence rates of this clinical condition have been estimated to be between 50-90%.¹

           Investigators have classified the differential diagnosis of low back pain mainly into mechanical causes (no primary inflammatory or neoplastic cause – 97%), visceral causes (no primary involvement of the spine – 2%), and non mechanical causes (Neoplasia, Infection, inflammatory arthritis etc – 1%). Many uncomplicated low back pain cases are assumed to result as a result of muscle sprains and strains, ligamentous injuries, and spinal degenerative changes. Disc herniation with nerve root compression or irritation has been proposed to be the most common cause of neurologic abnormalities.²

The lumbo-sacral region, being the most important region in the vertebral column in terms of mobility and weight bearing, mechanical disorders of this region cause LBP. Various studies have examined the relationship between changes in the angles of the lumbar spine and LBP and have shown significant differences in saggital profile of the lumbar spine between asymptomatic subjects and patients with LBP.³

Loss or flattening of the normal lumbar lordosis is an important clinical sign of back problems as the patient is thought to keep the spine in a upright and straight position, to reduce pain. But some studies suggests that, patients with chronic LBP have either no difference or increased lumbar lordosis with respect to controls, which shows  that, variations of the lumbar spine may / may not relate to reported symptoms.⁴ These lumbar anatomical changes would lead to an increased anterior tilt of the pelvis and an exaggerated lumbar lordosis during relaxed standing.⁵

                  There still exists a controversy in the scientific literature regarding lumbo-sacral posture and low back pain. Thoracic kyphosis, lumbar lordosis, pelvic tilt, and abdominal strength are the most investigated parameters, with respect to low back pain.⁶

Conventionally, LBP assessment is based on clinical diagnosis and is best established with an abnormality, evident in a radiograph. For the detection of pathological changes of the spine shape, the gold standard remains to be, the clinical examination along with radiological techniques such as X-ray, CT and MRI until today. The radiation from these diagnostic procedures leads to a very critical deployment for follow-up examinations, particularly in young patients. For this reason, simple, but inaccurate and poorly reliable methods were developed for follow-up examinations of the spine like the kyphometer or the curve ruler. More advanced methods like VICON Video System or the ultrasound-based Zebris- System were developed eventually, which were based upon the placement of marker on the skin over bony landmarks of the patients. These techniques were then found, to lead to measuring errors due to a possible shift of the skin over the underlying bony structures.⁷

This study uses surface topography to compare the spinal and pelvic patterns in patients with LBP with that of normal subjects. It is a validated, reliable, precise, radiation-free and inexpensive method for detecting the spinal posture, developed in early 1980’s, based on the technology of raster-stereography (RSG). This might help resolve some of the controversy and be useful in identifying patterns that may be associated with LBP. To our knowledge, no studies have been reported to be done, on spinal and pelvic postural deviations in LBP using surface topography. The paucity of scientific information available to support the spinal and pelvic postural deviations in LBP may be tackled with this study. This may aid in the diagnosis and treatment of LBP patients and also affect the planning of a proper exercise program for the back / abdominal muscle.