Relações entre pronação excessiva, alterações no alinhamento lombopélvico e ocorrência de lombalgia inespecífica: revisão sistemática

Abstract

Low back pain is a clinical condition with high prevalence in the population and is associated with impaired functional performance. As its clinical heterogeneous and multifactorial in origin, some authors suggest that it is essential to identify subgroups of individuals with low back pain characteristics and patterns associated with the assessment that may respond better to a specific conduct. In this context, considering that the lower limbs are the basis for sustaining the body and its movements in closed kinematic chain can affect the biomechanics of the pelvis and the spine, the aim of this study was to conduct a systematic review to verify the existence of relationships between excessive pronation of the subtalar joint of ankle-foot complex, changes in the alignment of the pelvis and spine, and occurrence of nonspecific low back pain. Eletronic search was made of scientific articles published from 1988 to 2010 using keywords related to pronation and back pain, excluding studies of lower limbs dysmetria and research that correlated flat foot and back pain. Among the nine selected studies, five were biomechanical studies, three were clinical studies and one study conducted biomechanical analysis and clinical intervention. Were extracted from the studies: the objectives, the number of participants, the characteristics of the groups analyzed, the evaluation methods of movement on the foot, on the pelvis and/or on the lumbar spine, the main findings and the limitations observed in each methodology. With respect to biomechanical studies, one study found relations between excessive pronation, changes in the pelvic alignment and back pain. Two biomechanical studies have reported correlations between increased pronation and changes in pelvic alignment, while two other studies did not agree. Among the clinical studies, two were against the existence of a relationship between pronation and low back pain, and a case study was supportive to this correlation. The biomechanical study that conducted clinical intervention identified relationships between pronation and back pain. From this set of information for and against, this study concluded that the literature is very limited in this issue and it is inconsistent to affirm the biomechanics relations between excessive pronation and changes in the alignment of the pelvis and lumbar spine, and the clinical relations between excessive pronation and low back pain. In this inconclusive context of need for further research, it is suggested that the approach of patients with nonspecific low back pain must be individualized and careful, trying to test the hypotheses identified in the evaluation that explain the origin of low back pain, among which we cannot yet exclude the changes in the movements of the foot.