Association of back pain and pelvic tilt during gait in individuals with cerebral palsy

Background: Back pain prevalence may increase with lumbar lordosis during standing in individuals with cerebral palsy (CP). Multiple interventions undertaken in individuals with CP have been shown to increase anterior pelvic tilt. Research question: Are pelvic tilt and trunk tilt (proxy measurements for lumbar lordosis) during gait associated with back pain prevalence in ambulatory individuals with CP? Methods: A retrospective investigation was performed among all patients with cerebral palsy visiting a single clinical motion analysis laboratory over a 3.5 year period (January 2015 – May 2018) who also had complete pain questionnaire data. Back pain prevalence and its association with sagittal plane kinematic parameters (pelvic tilt and trunk tilt) were analyzed. Results: Among the 700 patients that met the inclusion criteria, 594 were children and 106 were adults. Back pain prevalence was 11.1% in children and 36.8% in adults. As pelvic tilt and age increased, back pain increased (odds ratio 95% confidence interval: 1.002–1.061 and 1.052–1.109, respectively). Walking with an assistive device was not associated with back pain, nor was trunk tilt. Significance: Back pain was more common with increasing age in ambulatory individuals with CP. After controlling for assistive device use and age, there was a weak relationship between pelvic tilt and back pain. Future studies are needed to determine if this is this a causal relationship.