背景: 下背痛爲現代生活中廣泛常見的健康問題，不僅讓疼痛者於個人身心、財務狀況帶來巨大衝擊，同時增加了社會衛福事業的負擔。文獻指出在所有下背痛族群中，大約有80%的個案爲非特異性下背痛。非特異性下背痛並沒有結構上的病理性改變，往往誘發或增強疼痛的來源是機械性因素(例如:運動)。目前，臨床上主要常用於區分不同類型機械性下背痛的方法為功能性動作評估;然而，功能性評估的結果可能因研究對象、評估過程、分析方法的不同，而導致沒有較一致的結果。此外，骨盆的排列形態也與腰痛緊密相關，然而目前相關研究還不夠具體且充滿爭議。因此，本研究針對一般男性的慢性非特異性下背痛人群和無下背痛人群，比較他們在俯臥姿勢(prone)進行下肢旋轉動作時髖關節及腰椎-骨盆動作模式和靜態站立時骨盆不對稱情況，並探討動作模式差異與骨盆不對稱性的關聯性。
方法: 本實驗招募40位男性受試者，分爲非特異性下背痛組(NSLBP)20人和無下背痛對照組(CONTROL)20人。兩組人員均需填寫個人基本資料，而非特異性下背痛組會再填寫腰痛相關量表；接著兩組人員均進行相同的動作學參數測量，包括靜態站立位骨盆測量和動態俯臥位腰椎-骨盆-髖關節動作模式測量兩部分；動態測量包括慣用側和非慣用側的主動和被動髖關節內旋及外旋。收案過程中，會在受試者左右兩側肢段各四個部位(髂前上棘、髂後上棘、膝蓋外側、踝關節外側)貼上非侵入式反光球，並使用紅外線攝影機擷取反光球在立體空間位置資訊。最後根據坐標信息，計算骨盆不對稱率和腰椎-骨盆、髖關節旋轉角度，並比較兩組的差異性和關聯性，並用獨立T檢定比較兩組運動學參數的差異性。
结果: 對於骨盆排列情況來說，非特異性下背痛組的慣用側與非慣用側髂前上棘和髂後上棘連線與Z軸的夾角（αd 和αnd ）均顯著大於對照組(p<0.001)。對於骨盆-腰椎-髖關節運動模式來說，在非特異性下背痛組，慣用側的被動最大髖關節內旋角度與同側主動最大髖關節內旋角度的差值（DNSLBP = 13.25°±9.57°; DCONTRO =3.15°±11.95°;p=0.007）顯著大於對照組。以上兩個參數(αd 與D;αnd與D)間有顯著相關關係，相關係數分別爲r=0.577和r=0.593。而对于骨盆不對稱参数、主動和被動髋關節內旋、外旋角度、腰椎-骨盆和髋關節转动时序關係等参数，两组间没有顯著性差異。
結論: 兩組的骨盆不對稱性參數差異並不顯著，可能說明只針對骨性結構分析不能明確診斷出非特異性下背痛的致痛原因，臨床診斷過程中應該同時考慮功能性評估和軟組織特性性能評估，比如:肌肉力量，主動肌和拮抗肌發展平衡程度，關節活動角度等。另外對於無參與旋轉相關運動的男性下背痛人群來說，實施骨盆-腰椎-髖關節檢查似乎必要性不充分。

Background: Low back pain is one kind of very common pain issues which bring too much physical and psychological pressure for publics and financial burdens crushing the whole societies. There are around 80% low back pain who are considered as non-specific low back pain (NSLBP) patients. The pain is not led by structural pathology alternation but mechanical factors like sport. Recently, the main classification for distinguishing non-specific low back group into different subgroups is functional evaluation. However, there is no unanimous view about it because of inconsistency from the way of evaluation and analysis or research objects. Besides, the evidence discussing about the relationship between pelvic alignment and low back pain is inadequate and full of controversy. Therefore, we have investigated the differences of lumbopelvic-hip movement pattern and pelvic asymmetry and discussed the relationship between them for NSLBP group and asymptomatic group.
Methods: Twenty males with NSLBP (NSLBP group) and 20 males without NSLBP (control group) were recruited in control group. Each group were asked to provide their basic information, and subjects in NSLBP group also need to fill in the questionnaires. In addition, subjects in two groups have taken part in the same kinematic data collection including pelvic asymmetry in static standing position and lumbopelvic-hip movement pattern in prone position. The movement tasks involved the dominant and nondominant hip later and medial rotation in active and passive way. The non-invasive reflective balls localizing the lumbopelvic segments and lower extremity position were sticked on anterior superior ilium supine (ASIS), posterior superior ilium supine (PSIS), lateral knee line and lateral malleolus in left and right sides. The kinematic parameters like pelvic asymmetry ratio and lumbopelvic and hip rotation angle could be calculated and analyzed.
Results: Un-paired T test was used to compare the difference of kinematic parameters between two groups. For pelvic alignment, the larger angles between link-line of ASIS & PSIS and z-axis in dominant side and nondominant side (αd and αnd) could be found in NSLBP group (p<0.001). In terms of lumbopelvic-hip movement pattern, the difference of maximal hip medial rotation angle between passive and active pattern in dominant side (D) in NSLBP group was significantly larger than control group (DNSLBP = 13.25°±9.57°; DCONTRO =3.15°±11.95°; p=0.007). The Pearson's r between αd & D and αnd & D were significant, Rαnd & D = 0.593 and Rαd & D =0.577, respectively. Parameters relating pelvic asymmetry, active and passive hip joint lateral and medial rotation angle, and time-sequence of movement between lumbopelvic segment and hip joint between two groups were no significant difference in our study.
Conclusion: These findings may suggest that diagnosis focusing bone structural alignment is not efficient enough during clinical evaluation, which means much more movement or functional assessment for soft tissues properties like muscle strength, relative development level between prime mover and antagonistic muscle and range of motion angle should be involved. Also, whether adding lumbar-pelvis-hip movement pattern and pelvic symmetry measurement into regular clinical assessment for NSLBP subjects should be considered carefully, because these two domains may depend on physical behavior like the types of sports or activity they have joined in regularly.

Adams, M. A., Burton, K., & Bogduk, N. (2006). The biomechanics of back pain (Vol. 55): Elsevier health sciences.
Ágústsson, A., Sveinsson, Þ., & Rodby-Bousquet, E. (2017). The effect of asymmetrical limited hip flexion on seating posture, scoliosis and windswept hip distortion. Research in Developmental Disabilities, 71, 18-23.
Al-Eisa, E., Egan, D., Deluzio, K., & Wassersug, R. (2006). Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain. Spine, 31(3), E71-E79.
Almeida, G. P. L., de Souza, V. L., Sano, S. S., Saccol, M. F., & Cohen, M. (2012). Comparison of hip rotation range of motion in judo athletes with and without history of low back pain. Manual Therapy, 17(3), 231-235.
Alrwaily, M., Timko, M., Schneider, M., Kawchuk, G., Bise, C., Hariharan, K., . . . Delitto, A. (2017). Treatment-based classification system for patients with low back pain: the movement control approach. Physical therapy, 97(12), 1147-1157.
Alter, M. J. (2004). Science of flexibility: Human Kinetics.
Barbee Ellison, J., Rose, S. J., & Sahrmann, S. A. (1990). Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Physical therapy, 70(9), 537-541.
Barrey, C., Jund, J. m., Noseda, O., & Roussouly, P. (2007). Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. European Spine Journal, 16(9), 1459-1467.
Burns, B. D. (2013). An evidence-based approach to the evaluation and treatment of low back pain in the emergency department. Emergency medicine practice, 2.
Burroughs, B. R., Hallstrom, B., Golladay, G. J., Hoeffel, D., & Harris, W. H. (2005). Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes: an in vitro study. The Journal of arthroplasty, 20(1), 11-19.
Bussey, M. D. (2010). Does the demand for asymmetric functional lower body postures in lateral sports relate to structural asymmetry of the pelvis? Journal of science and medicine in sport, 13(3), 360-364.
Carlsson, A. M. (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 16(1), 87-101.
Chaléat-Valayer, E., Mac-Thiong, J.-M., Paquet, J., Berthonnaud, E., Siani, F., & Roussouly, P. (2011). Sagittal spino-pelvic alignment in chronic low back pain. European Spine Journal, 20(5), 634-640.
Chenot, J.-F., Greitemann, B., Kladny, B., Petzke, F., Pfingsten, M., & Schorr, S. G. (2017). Non-specific low back pain. Deutsches Ärzteblatt International, 114(51-52), 883.
Christe, G., Redhead, L., Legrand, T., Jolles, B. M., & Favre, J. (2016). Multi-segment analysis of spinal kinematics during sit-to-stand in patients with chronic low back pain. Journal of biomechanics, 49(10), 2060-2067.
Christie, H. J., Kumar, S., & Warren, S. A. (1995). Postural aberrations in low back pain. Archives of Physical Medicine and Rehabilitation, 76(3), 218-224.
Cibulka, M. T., Sinacore, D. R., Cromer, G. S., & Delitto, A. (1998). Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine, 23(9), 1009-1015.
Coenen, P., Kingma, I., Boot, C. R., Twisk, J. W., Bongers, P. M., & van Dieën, J. H. (2013). Cumulative low back load at work as a risk factor of low back pain: a prospective cohort study. Journal of occupational rehabilitation, 23(1), 11-18.
Cohen, S. P., Argoff, C. E., & Carragee, E. J. (2008). Management of low back pain. Bmj, 337, a2718.
Dagenais, S., Caro, J., & Haldeman, S. (2008). A systematic review of low back pain cost of illness studies in the United States and internationally. The Spine Journal, 8(1), 8-20.
Dario, A. B., Ferreira, M. L., Refshauge, K. M., Lima, T. S., Ordonana, J. R., & Ferreira, P. H. (2015). The relationship between obesity, low back pain, and lumbar disc degeneration when genetics and the environment are considered: a systematic review of twin studies. The Spine Journal, 15(5), 1106-1117.
Egan, D. A., Cole, J., & Twomey, L. (1999). An alternative method for the measurement of pelvic skeletal asymmetry (PSA) using an asymmetry ratio (AR). Journal of Manual & Manipulative Therapy, 7(1), 11-19.
Esola, M. A., McClure, P. W., Fitzgerald, G. K., & Siegler, S. (1996). Analysis of lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain. Spine, 21(1), 71-78.
Fairbank, J., Couper, J., Davies, J., & O’brien, J. (1980). The Oswestry low back pain disability questionnaire. Physiotherapy, 66(8), 271-273.
Fairbank, J., Gwilym, S. E., France, J. C., Daffner, S. D., Dettori, J., Hermsmeyer, J., & Andersson, G. (2011). The role of classification of chronic low back pain. Spine, 36, S19-S42.
Fann, A. V. (2002). The prevalence of postural asymmetry in people with and without chronic low back pain. Archives of Physical Medicine and Rehabilitation, 83(12), 1736-1738.
Ferreira, P. H., Beckenkamp, P., Maher, C. G., Hopper, J. L., & Ferreira, M. L. (2013). Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples. European Journal of Pain, 17(7), 957-971.
Ghamkhar, L., & Kahlaee, A. H. (2015). Trunk muscles activation pattern during walking in subjects with and without chronic low back pain: a systematic review. PM&R, 7(5), 519-526.
Gnat, R., & Biały, M. (2015). A new approach to the measurement of pelvic asymmetry: proposed methods and reliability. Journal of manipulative and physiological therapeutics, 38(4), 295-301.
Gnat, R., Saulicz, E., Biały, M., & Kłaptocz, P. (2009). Does pelvic asymmetry always mean pathology? Analysis of mechanical factors leading to the asymmetry. Journal of Human kinetics, 21(1), 23-32.
Gombatto, S. P., Collins, D. R., Sahrmann, S. A., Engsberg, J. R., & Van Dillen, L. R. (2006). Gender differences in pattern of hip and lumbopelvic rotation in people with low back pain. Clinical Biomechanics, 21(3), 263-271.
Gordon, S. J., Yang, K. H., Mayer, P. J., Mace Jr, A. H., Kish, V. L., & Radin, E. L. (1991). Mechanism of disc rupture. A preliminary report. Spine, 16(4), 450-456.
Harris-Hayes, M., Sahrmann, S. A., & Van Dillen, L. R. (2009). Relationship between the hip and low back pain in athletes who participate in rotation-related sports. Journal of sport rehabilitation, 18(1), 60-75.
Harris-Hayes, M., & Van Dillen, L. R. (2009). The inter-tester reliability of physical therapists classifying low back pain problems based on the movement system impairment classification system. PM&R, 1(2), 117-126.
Harrison, D. D., Cailliet, R., Janik, T. J., Troyanovich, S. J., Harrison, D. E., & Holland, B. (1998). Elliptical modeling of the sagittal lumbar lordosis and segmental rotation angles as a method to discriminate between normal and low back pain subjects. Journal of spinal disorders, 11(5), 430-439.
Hellebrandt, F., & Houtz, S. J. (1956). Mechanisms of muscle training in man: experimental demonstration of the overload principle. Physical therapy, 36(6), 371-383.
Heneweer, H., Staes, F., Aufdemkampe, G., van Rijn, M., & Vanhees, L. (2011). Physical activity and low back pain: a systematic review of recent literature. European Spine Journal, 20(6), 826-845.
Hetsroni, I., Poultsides, L., Bedi, A., Larson, C. M., & Kelly, B. T. (2013). Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clinical Orthopaedics and Related Research®, 471(8), 2497-2503.
Hodges, P., van den Hoorn, W., Dawson, A., & Cholewicki, J. (2009). Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. Journal of biomechanics, 42(1), 61-66.
Hoffman, S. L., Johnson, M. B., Zou, D., & Van Dillen, L. R. (2011). Sex differences in lumbopelvic movement patterns during hip medial rotation in people with chronic low back pain. Archives of Physical Medicine and Rehabilitation, 92(7), 1053-1059.
Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., . . . Buchbinder, R. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028-2037.
Hoy, D., Brooks, P., Blyth, F., & Buchbinder, R. (2010). The epidemiology of low back pain. Best practice & research Clinical rheumatology, 24(6), 769-781.
Jackson, R. P., & McManus, A. C. (1994). Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine, 19(14), 1611-1618.
Jancuska, J. M., Spivak, J. M., & Bendo, J. A. (2015). A review of symptomatic lumbosacral transitional vertebrae: Bertolotti's syndrome. International journal of spine surgery, 9.
Juhl, J. H., Cremin, T. M. I., & Russell, G. (2004). Prevalence of frontal plane pelvic postural asymmetry—part 1. The Journal of the American Osteopathic Association, 104(10), 411-421.
Kim, H.-K., & Zhang, Y. (2017). Estimation of lumbar spinal loading and trunk muscle forces during asymmetric lifting tasks: application of whole-body musculoskeletal modelling in OpenSim. Ergonomics, 60(4), 563-576.
Kim, W.-d., & Shin, D. (2020). Correlations Between Hip Extension Range of Motion, Hip Extension Asymmetry, and Compensatory Lumbar Movement in Patients with Nonspecific Chronic Low Back Pain. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, e925080-925081.
Klineberg, E., Schwab, F., Smith, J. S., Gupta, M. C., Lafage, V., & Bess, S. (2013). Sagittal spinal pelvic alignment. Neurosurgery Clinics, 24(2), 157-162.
Koes, B., Van Tulder, M., & Thomas, S. (2006). Diagnosis and treatment of low back pain. Bmj, 332(7555), 1430-1434.
Koes, B. W., Van Tulder, M., Lin, C.-W. C., Macedo, L. G., McAuley, J., & Maher, C. (2010). An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal, 19(12), 2075-2094.
Lardon, A., Leboeuf-Yde, C., Le Scanff, C., & Wedderkopp, N. (2014). Is puberty a risk factor for back pain in the young? a systematic critical literature review. Chiropractic & manual therapies, 22(1), 27.
Lee, R. Y., & Wong, T. K. (2002). Relationship between the movements of the lumbar spine and hip. Human movement science, 21(4), 481-494.
Levangie, P. K. (1999). The association between static pelvic asymmetry and low back pain. Spine, 24(12), 1234-1242.
Mahato, N. K. (2019). Asymmetric sacroiliac joint anatomy in partial lumbosacral transitional variations: potential impact on clinical testing in sacral dysfunctions. Medical hypotheses, 124, 110-113.
Marras, W. S., Lavender, S. A., Leurgans, S. E., Fathallah, F. A., Ferguson, S. A., Gary Allread, W., & Rajulu, S. L. (1995). Biomechanical risk factors for occupationally related low back disorders. Ergonomics, 38(2), 377-410.
Masset, D., Malchaire, J., & Lemoine, M. (1993). Static and dynamic characteristics of the trunk and history of low back pain. International Journal of Industrial Ergonomics, 11(4), 279-290.
McGill, S. M. (1997). The biomechanics of low back injury: implications on current practice in industry and the clinic. Journal of biomechanics, 30(5), 465-475.
McKenzie, R., & May, S. (2003). The lumbar spine: mechanical diagnosis and therapy (Vol. 1): Orthopedic Physical Therapy.
Miki, H., Kyo, T., Kuroda, Y., Nakahara, I., & Sugano, N. (2014). Risk of edge-loading and prosthesis impingement due to posterior pelvic tilting after total hip arthroplasty. Clinical Biomechanics, 29(6), 607-613.
Murray, E., Birley, E., Twycross-Lewis, R., & Morrissey, D. (2009). The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: an observational study. Physical Therapy in Sport, 10(4), 131-135.
Newcomer, K., Laskowski, E. R., Yu, B., Larson, D. R., & An, K.-N. (2000). Repositioning error in low back pain: comparing trunk repositioning error in subjects with chronic low back pain and control subjects. Spine, 25(2), 245.
Parreira, P., Maher, C. G., Steffens, D., Hancock, M. J., & Ferreira, M. L. (2018). Risk factors for low back pain and sciatica: an umbrella review. The Spine Journal, 18(9), 1715-1721.
Peters, M. (1988). Footedness: asymmetries in foot preference and skill and neuropsychological assessment of foot movement. Psychological Bulletin, 103(2), 179.
Pinheiro, M. B., Ferreira, M. L., Refshauge, K., Ordoñana, J. R., Machado, G. C., Prado, L. R., . . . Ferreira, P. H. (2015). Symptoms of depression and risk of new episodes of low back pain: a systematic review and meta‐analysis. Arthritis care & research, 67(11), 1591-1603.
Porter, J. L., & Wilkinson, A. (1997). Lumbar-hip flexion motion: a comparative study between asymptomatic and chronic low back pain in 18-to 36-year-old men. Spine, 22(13), 1508-1513.
Rajnics, P., Templier, A., Skalli, W., Lavaste, F., & Illes, T. (2002). The importance of spinopelvic parameters in patients with lumbar disc lesions. International orthopaedics, 26(2), 104-108.
Razmjou, H., Kramer, J. F., & Yamada, R. (2000). Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low back pain. Journal of Orthopaedic & Sports Physical Therapy, 30(7), 368-389.
Reiman, M. P., Weisbach, P. C., & Glynn, P. E. (2009). The hip’s influence on low back pain: a distal link to a proximal problem. Journal of sport rehabilitation, 18(1), 24-32.
Roussouly, P., Gollogly, S., Berthonnaud, E., & Dimnet, J. (2005). Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine, 30(3), 346-353.
Sadeghisani, M., Manshadi, F., Kalantari, K., Rahimi, A., Namnik, N., Karimi, M., & Oskouei, A. (2015). Correlation between Hip Rotation Range-of-Motion Impairment and Low Back Pain. A Literature Review. Ortopedia, traumatologia, rehabilitacja, 17(5), 455-462.
Sahrmann, S. (2002a). Diagnosis and Treatment of Movement Impairment Syndromes; Mosby: St. Louis, MO, USA.
Sahrmann, S. (2002b). Movement impairment syndromes of the lumbar spine. Diagnosis and treatment of movement impairment syndromes, 1, 5-118.
Sahrmann, S., Azevedo, D. C., & Van Dillen, L. (2017). Diagnosis and treatment of movement system impairment syndromes. Brazilian journal of physical therapy, 21(6), 391-399.
Scholtes, S. A., Gombatto, S. P., & Van Dillen, L. R. (2009). Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests. Clinical Biomechanics, 24(1), 7-12.
Shum, G. L., Crosbie, J., & Lee, R. Y. (2005). Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit. Spine, 30(17), 1998-2004.
Shum, G. L., Crosbie, J., & Lee, R. Y. (2007). Three-dimensional kinetics of the lumbar spine and hips in low back pain patients during sit-to-stand and stand-to-sit. Spine, 32(7), E211-E219.
Shum, G. L., Crosbie, J., & Lee, R. Y. (2009). Energy transfer across the lumbosacral and lower-extremity joints in patients with low back pain during sit-to-stand. Archives of Physical Medicine and Rehabilitation, 90(1), 127-135.
Sorensen, C. J., Johnson, M. B., Norton, B. J., Callaghan, J. P., & Van Dillen, L. R. (2016). Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing. Human movement science, 50, 38-46.
Sueki, D. G., Cleland, J. A., & Wainner, R. S. (2013). A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. Journal of Manual & Manipulative Therapy, 21(2), 90-102.
Vad, V., Gebeh, A., Dines, D., Altchek, D., & Norris, B. (2003). Hip and shoulder internal rotation range of motion deficits in professional tennis players. Journal of science and medicine in sport, 6(1), 71-75.
Vad, V. B., Bhat, A. L., Basrai, D., Gebeh, A., Aspergren, D. D., & Andrews, J. R. (2004). Low back pain in professional golfers: the role of associated hip and low back range-of-motion deficits. The American journal of sports medicine, 32(2), 494-497.
van Dieën, J. H., Selen, L. P., & Cholewicki, J. (2003). Trunk muscle activation in low-back pain patients, an analysis of the literature. Journal of electromyography and kinesiology, 13(4), 333-351.
Van Dillen, L., Sahrmann, S., & Maluf, K. (2003). Effect of modifying patient-preferred movement and alignment strategies during symptom testing in patients with low back pain: a follow-up report. J Orthop Sports Phys Ther, 33, A4.
Van Dillen, L. R., Bloom, N. J., Gombatto, S. P., & Susco, T. M. (2008). Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Physical Therapy in Sport, 9(2), 72-81.
Van Dillen, L. R., Gombatto, S. P., Collins, D. R., Engsberg, J. R., & Sahrmann, S. A. (2007). Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain. Archives of Physical Medicine and Rehabilitation, 88(3), 351-360.
Van Dillen, L. R., Sahrmann, S. A., Norton, B. J., Caldwell, C. A., McDonnell, M. K., & Bloom, N. (2003). The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. Archives of Physical Medicine and Rehabilitation, 84(3), 313-322.
Van Dillen, L. R., Sahrmann, S. A., Norton, B. J., Caldwell, C. A., McDonnell, M. K., & Bloom, N. J. (2003). Movement system impairment-based categories for low back pain: stage 1 validation. Journal of Orthopaedic & Sports Physical Therapy, 33(3), 126-142.
Waddell, G., Newton, M., Henderson, I., Somerville, D., & Main, C. J. (1993). A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain, 52(2), 157-168.
Yu, Q., Huang, H., Zhang, Z., Hu, X., Li, W., Li, L., . . . Wang, C. (2020). The association between pelvic asymmetry and non-specific chronic low back pain as assessed by the Global Postural System.
魏善華. (2009). 下背痛盛行率及患者接受脊椎手術與脊椎內固定器之相關研究---以健保資料庫分析.