Clinical tests for lumbar instability in low back pain
Low back pain is a common health condition and its prevalence is still increasing. Low back pain can be divided into subgroups, one of them being lumbar segmental instability. Some authors refer to the concept of instability also considering the so-called “clinical” or “functional” instability, which states there is no defect in the lumbar spine and no detectable translation or rotation. However, until today it is believed that a poor trunk muscle function and/ or an insufficient motor control are present an in abnormal inter-segmental movement in LBP.
There have been various studies investigating tools enabling physiotherapists to diagnose lumbar segmental instability. The most used tests are the Prone Instability Test (PIT), the Passive Lumbar Extension (PLE) test, the Aberrant Movements Pattern (AMP), the Posterior Shear Test (PST), the Prone Bridge Test (PBT), the Supine Bridge Test (SBT), and the Active Straight Leg Raise Test.
This article provides a systematic review with the most recent studies regarding clinical tests for diagnosing lumbar segmental instability. Two reviewers used different tools for the two types of studies: the included articles were assessed using the QUADAS tool and the QAREL checklist.
Data from this review suggest the PLE is the most reliable test for diagnosing lumbar segmental instability because of its excellent diagnostic accuracy and good reliability. Nevertheless, more research on the diagnostic properties of the PLE test to detect lumbar instability among different populations with LBP is suggested. The other tests showed conflicting results when comparing the studies with each other.
> From: Ferrari et al., Chiropr Man Therap (2016) 12(Epub ahead of print). All rights reserved to The Author(s). Click here for the Pubmed summary.