No association between measurements of spinal curves and pain, review
Two pages on PainSci cite Christensen 2008: 1. The Complete Guide to Low Back Pain 2. Your Back Is Not Out of Alignment
PainSci notes on Christensen 2008:
This review of more than 50 studies found no association between measurements of spinal curves and pain. The authors’ conclusion was decisive: the evidence “does not support an association between sagittal spinal curves and health including spinal pain.” One can cherry pick the data for a few studies that show some minor correlation, but it averages out to nothing to write home about.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVES: The purposes of this study were to (1) determine whether sagittal spinal curves are associated with health in epidemiological studies, (2) estimate the strength of such associations, and (3) consider whether these relations are likely to be causal.
METHODS: A systematic critical literature review of epidemiological (cross-sectional, case-control, cohort) studies published before 2008 including studies identified in the CINAHL, EMBASE, Mantis, and Medline databases was performed using a structured checklist and a quality assessment. Level of evidence analysis was performed as outlined by van Tulder et al (Spine. 2003;28:1290-9), and the strength of associations were determined using the procedure outlined by Hemingway and Marmot (BMJ. 1999;318:1460-7). Quality of the included articles were assessed by our own scoring system based on the STrengthening the Reporting of OBservational studies in Epidemiology checklist. Studies scoring maximum points (4/4 or 3/3) were considered to be of higher quality.
RESULTS: Fifty-four original studies were included. We found no strong evidence for any association between sagittal spinal curves and any health outcomes including spinal pain. The included studies were generally of low methodological quality. There is moderate evidence for association between sagittal spinal curves and 4 health outcomes as follows: temporomandibular disorders (no odds ratios [ORs] provided), pelvic organ prolapse (OR, 3.18; 95% confidence interval [CI], 1.46-96.93), daily function (OR range, 1.8-3.7; 95% CI range, 1.1-6.3), and death (OR, 1.40; 95% CI, 1.08-1.91). These associations are however unlikely to be causal.
CONCLUSIONS: Evidence from epidemiological studies does not support an association between sagittal spinal curves and health including spinal pain. Further research of better methodological quality may affect this conclusion, and causal effects cannot be determined in a systematic review.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial. Friedly 2017 Arch Phys Med Rehabil.
- Cannabis-based medicines for chronic neuropathic pain in adults. Ateş 2026 Cochrane Database Syst Rev.
- Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis. Munro 2026 Br J Sports Med.
- Optimizing elastic band resistance training for Metabolic Syndrome components in older adults: A systematic review, meta-analysis, and meta-regression of randomized controlled trials. Saez-Berlanga 2026 Arch Phys Med Rehabil.
- Biomechanical insights into Achilles tendinopathy risk and protection in runners: a large prospective study 4HAIE. Jandacka 2026 Br J Sports Med.