Passive Lumbar Extension Research Articles

선별적 집중 전신전기자극 훈련이 요추 불안정 대상자들의 요추 안정성 및 보행기능에 미치는 효과 : 무작위 맹검 대조군 연구

The purpose of this study was to identify the effects of selective intensive Whole-body electromyostimulation(WB-EMS) training on the lumbar stability, and gait function of subjects with lumbar instability. There were recruited 34 subjects with lumbar instability for this study. They were selected to have tested positive through the prone instability test and passive lumbar extension test. They were randomly divided into experimental group (n=17) with WB-EMS and control group (n=17) without WB-EMS, respectively. Both groups received a total of 45 minutes of intervention programs, respectively. Measurements were used before and after the intervention. The lumbar instability was measured by the single limb stance test and plank test. The gait function was used the gait analysis. The following statistical analysis was performed: an independent t-test for the general characteristics of the subjects, 2×2 analysis of variance with repeated measures for the lumbar instability and gait function. The group×time interaction effect showed significant improvement in the right single limb stance (F=5.445, p=.026), left single limb stance (F=4.245, p=.048) and plank test (F=4.341, p=.045) in lumbar stability test, And also, velocity (F=4.360, p=.045), cadence( F=4.681, p=.038), step time (F=5.261, p=.029) and step length (F=20.149, p=.000) of gait analysis. This study suggest that WB-EMS may be effective exercise for the lumbar stability and gait function in subjects with lumbar instability.

Prevalence of Lumbar Segmental Instability in Young Individuals with the Different Types of Lumbar Disc Herniation-Preliminary Report.

Lumbar segmental instability (LSI) can cause pain and disability, and its background can be related to lumbar disc herniation (LDH). This retrospective study was conducted to analyze the prevalence of lumbar segmental instability (LSI) in young patients with different types of lumbar disc herniation (LDH). The study evaluated 133 individuals (18–25 years old) who suffered from LDH and underwent MRI and flexion-extension X-rays. Two groups were created: protrusion (PRO) and extrusion (EXT). LSI was scored positive when translatory motion was greater than 4 mm anteriorly or 2 mm posteriorly at the level of herniation. Statistica 13 was used to perform statistics. The LSI overall prevalence was 18.33% in PRO and 21.92% in EXT (p > 0.05). Out of all LSI positives, higher LSI incidence was observed in females compared to males; in PRO: 63.64%; in EXT: 68.75% (p > 0.05). LSI correlated positively with the passive lumbar extension test (PLE) (R = 0.32; p = 0.01) in the PRO group only. In summary, the results showed that the overall incidence of LSI was higher with severer disc damage. In addition, females were more prone to this pathology. However, the different types of LDH do not significantly affect the prevalence of LSI in young individuals.

Correlation between Spinal Instability and Ankle Injuries in Amateur Marathon Runners

Background: Marathon running is becoming more popular among middle-aged people who have no prior running experience. Improper or incomplete knowledge increases the risk of injuries in amateur runners. Individuals with spinal instability experience alteration in balance control while walking as well as running which in turn results in asymmetrical bodyweight distribution throughout the lower extremity. This changes the pattern of running leading to injuries of hips, knees, and ankle. Methods: The objective of the study was to correlate spinal instability with ankle injuries in amateur marathon runners. In this study, both male and female amateur marathon runners between the age group of 20 and 45 years with normal body mass index (BMI) were chosen and individuals with the previous surgery as well as degenerative diseases of spine and ankle fractures were ruled out. Spinal instability tests were carried out on amateur marathon runners with symptoms of instability. Subjects were asked questions related to ankle injuries. Outcome measures used were Oswestry Disability Index (ODI) and tests for spinal instability. Results: About 57% of participants were tested positive for the passive lumbar extension test and 42% of participants were tested positive for the prone instability test. There was the presence of ankle pain (68%), ankle swelling (24%), heel pain (60%), blisters (42%), ankle sprain (28%), and strain (26%) in selected participants. There were 68% runners with minimal disability and 32% runners with moderate disability. Conclusion: Amateur marathon runners with spinal instability had the presence of ankle injuries like ankle pain, ankle swelling, heel pain, blisters, ankle sprain, and strain. Based on the test performed and interpretation of the ODI and after correlating spinal instability with ankle injuries, we concluded that spinal instability increases the risk of ankle injuries in amateur marathon runners.

Defining the lumbar and trunk-thigh neutral zone from the passive stiffness curve: application to hybrid sit-stand postures and chair design

Minimal data exist on the neutral position for the lumbar spine, trunk, and thighs when adopting a hybrid posture. This study examined sex differences in the neutral zone lumbar stiffness and the lumbar and trunk-thigh angle boundaries of the neutral zone, and determined if the standing lumbar angle fell within the neutral zone. Passive lumbar flexion and extension moment-angle curves were generated for 31 participants (13 M, 18 F), pooled from two datasets, with trunk-thigh angles available for 10 participants. The neutral zone was defined as the low stiffness zone from both the flexion and extension curves. Males demonstrated significantly greater extensor stiffness. Neutral lumbar and trunk-thigh angles ranged on average −22.2 to 0.2° and 124.2 to 159.6° for males and −17.8 to −1.3° and 143.2 to 159.5° for females, respectively. Standing lumbar angles fell outside the neutral zone for 44% of participants. These neutral zone boundaries may inform kinematics for hybrid chair designs. Practitioner summary: Adoption of a neutral spinal posture may be achieved through hybrid chair design, yet minimal data exists on a physiologically defined neutral zone. Using measures of in vivo lumbar stiffness, the lumbar and trunk-thigh angular boundaries of the neutral zone were defined for both males and females. Abbreviations: EMG: electromyography; MVC: maximal voluntary contraction

Combining clinical exams can better predict lumbar spine radiographic instability

Background/objectivesSeveral clinical tests have been proposed to diagnose lumbar instability, but their accuracy is still in question. The primary purpose of this study was to evaluate the diagnostic accuracy of the clinical lumbar instability tests. The secondary goal was to design a model to detect lumbar instability. DesignA prospective diagnostic cross-sectional study. MethodA sample of 202 patients with chronic low back pain were participated in the study. Five lumbar instability tests including Aberrant movement, Passive lumbar extension, Prone segmental instability, H and I and pheasant tests were compared to flexion/extension radiography as the gold standard for diagnosing lumbar instability using two by two tables. Multiple Logistic Regression analysis was applied to develop a model using demographic information as well as the patients’ pain intensity, disability level, lumbar lordosis and the clinical tests. ResultsAmong the five examined tests, Prone segmental instability, H and I and pheasant tests showed very small likelihood ratios and diagnostic odd's ratio. The largest values were for H and I test with the positive likelihood ratio of 1.28 (95% CI: 0.72 to 2.29) and diagnostic odd's ratio of 1.37 (95% CI: 0.66 to 2.83); the diagnostic accuracy measures were smaller for the other studied clinical tests. The model was developed using weight (t = 1.15, p = 0.03) and lumbar lordosis (t = 3.04, p = 0.00) (which showed a significant relationship with lumbar instability) and prone segmental instability test. The final model has the positive likelihood ratio of 2.07 (95% CI: 1.41 to 3.05) and diagnostic odd's ratio of 3.77 (95% CI: 2.03 to 7.01). ConclusionEach individual test had very small to no power in discriminating patients with lumbar instability. The developed model just slightly improved the accuracy of radiological instability detection.

Correlation between presence of Lumbar Instability, Physical function and Balance in subjects with knee osteoarthritis: An observational Study

BACKGROUND AND OBJECTIVES: Osteoarthritis (OA) of the knee is one of the most common musculoskeletal disorders that increase the global health burden. Various research aimed to improve pain and physical functions in individuals with OA knee have been conducted. However, there is a dearth of research evaluating coexisting lumbar instability and its impact on physical function limitation and risk of fall in individuals with knee OA, while there is a pool of research on kinetic chain evaluation including lumbar spine for the athletic population for injury prevention.METHODOLOGY: Twenty-two individuals with OA knee, aged 50–65 years (male or female) willing to participate in the study were included in the study. Demographic details including age, body mass index (BMI), and duration of knee pain were recorded. All the individuals were screened for the presence of lumbar segmental instability (using passive lumbar extension test), balance (using Dynamic Gait Index), and physical function using mWOMAC.RESULTS: Data were analyzed using SPSS. There were significantly greater (P < 0.05) deficits in balance and function of individuals with the presence of clinical lumbar segmental instability. In addition, BMI and duration of knee pain also correlated positively with balance and function deficits in all individuals.CONCLUSION: The presence of lumbar segmental instability in individuals with OA knee puts them at greater risk of falls due to altered balance and limits functional ability as well.

Predicting Upper Quadrant Musculoskeletal Injuries in the Military: A Cohort Study.

This study aimed to identify characteristics and movement-based tests that predict upper quadrant musculoskeletal injury (UQI) in military personnel over a 12-month follow-up. A prospective observational cohort study of military members (n = 494; 91.9% male) was conducted. Baseline predictors associated with UQI were gathered through surveys and movement-based tests. Survey data included demographic information, injury history, and biosocial factors. Movement-based tests include the following: Y Balance Tests (YBT), Functional Movement Screen, Selective Functional Movement Assessment lumbar multisegmental mobility, modified-modified Schober, side bridge, ankle mobility, modified Sorensen, and passive lumbar extension. Self-reported UQI was collected through monthly online surveys, and 87% completed the follow-up. Univariate associations were determined between potential predictors and UQI. A forward, stepwise logistic regression model was used to identify the best combination of predictors for UQI. Twenty-seven had UQI. Univariate associations existed with three demographic (smoking, >1 previous UQI, baseline upper quadrant function ≤90%), three pain-related (Selective Functional Movement Assessment rotation, side bridge, hurdle step), and six movement-based variables (YBT upper quarter (UQ) superolateral worst score ≤57.75 cm, YBT-UQ composite worst score ≤81.1%, failed shoulder clearance, Sorenson <72.14 s, in-line lunge total score <15, and in-line lunge asymmetry >1). Smoking, baseline upper quadrant function ≤90%, and YBT-UQ composite score ≤81.1% predicted UQI in the logistic regression while controlling for age and sex. Presenting two or more predictors resulted in good specificity (85.6%; odds ratio, 4.8; 95% confidence interval, 2.2-10.8), and at least one predictor resulted in 81.5% sensitivity (odds ratio, 3.2; 95% confidence interval, 1.2-8.7). A modifiable movement-based test (YBT-UQ), perceived upper limb function, and smoking predicted UQI. A specific (two or more) and sensitive (at least one predictor) model could identify persons at higher risk.

Mobilisation efficacy in young patients with different stages of degenerative disc disease.

Lumbar vertebrae carry the greatest load from the spinal column, often leading to several pathologies, including degenerative disc disease (DDD), potentially disturbing spinal movement patterns. Mobilisation increases hypomobile segment mobility, however there is little evidence on mobilisation in patients suffering from different types of DDD. To assess the efficacy of mobilisation in young patients with DDD, as diagnosed by MRI. Thirty patients (24-35 years) participated in this study, and were divided into two groups, based on progression levels of DDD diagnosed by MRI (protrusion-PRO/extrusion-EXT). Twenty sessions of sustained stretch mobilisation (grade III) were applied to both groups over four weeks. Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), straight leg raise (SLR), passive lumbar extension (PLE) and lumbar range of motion (ROM) assessed outcome variables. Three trial stages were investigated: pre-therapy (1), post-therapy (2) and follow-up (3). Age (p= 0.007) and NRS (p= 0.002) were significantly different before therapy. Patient outcomes were significantly improved for all parameters in both groups, except SLR which improved in the EXT group only (p= 0.043). Applied treatments improved patient outcomes and were statistically significant in both groups, however, better outcomes were observed in the EXT group during follow-up. Mobilisation was a safe and effective procedure for the treatment of DDD.

Relationship Between Proprioception and Pain and Disability in People With Non-Specific Low Back Pain: A Systematic Review With Meta-Analysis.

Systematic review with meta-analysis. To examine the association between proprioception and pain and disability in people with non-specific low back pain (NSLBP) and the impact of potential moderators on the strength of the association. NSLBP is a common musculoskeletal disorder and a leading cause of disability. Proprioception deficit has been associated with low back pain and correlated with pain and disability; however, the correlation coefficients presented are conflicting. Systematic literature search was performed in eight databases and Google scholar. Two independent reviewers assessed the literature and extracted data. Data of interest included participant characteristics of NSLBP group, pain and disability, proprioception test protocol, and the correlation coefficient between proprioception and pain/disability. Meta-analysis of data from homogeneous studies was performed according to proprioception test methods. Subgroup of movement directions was analyzed. The methodological quality of studies was assessed. The literature search identified 3067 records of which 14 studies were included for meta-analysis. Proprioception was measured by active joint repositioning sense (AJRS), passive joint repositioning sense (PJRS), and threshold to detect passive motion (TTDPM). Meta-analysis revealed no significant correlation coefficient between any proprioception measures and pain or disability (P > 0.05). The subgroup analysis showed little correlation between absolute error (AE) of passive lumbar flexion and pain (r = 0.225, 95% CI 0.040-0.395), and between AE of passive lumbar extension and disability (r = 0.196, 95%CI 0.010-0.369). AJRS and TTDPM are not correlated with pain and disability in people with NSLBP. The AE of passive lumbar movement is correlated to a small degree with pain and disability. However, the degree of correlation is small and should be interpreted with caution. Therefore, the differences in proprioception observed between people with pain and people without pain seem to be independent of the symptoms. 1.

Association Between Clinical Tests Related to Motor Control Dysfunction and Changes in Pain and Disability After Lumbar Stabilization Exercises in Individuals With Chronic Low Back Pain

ObjectiveTo investigate whether clinical tests used to detect motor control dysfunction can predict improvements in pain and disability in patients with chronic nonspecific low back pain (LBP) who have undergone an 8-week lumbar stabilization exercise program. Study DesignA prospective cohort study. SettingOutpatient physical therapy university clinic. ParticipantsSeventy people with chronic nonspecific LBP were recruited, and 64 completed the exercise program (N=64). InterventionsThe lumbar stabilization program was provided twice a week for 8 weeks. Main Outcome MeasuresPain intensity (11-point numerical rating scale) and disability (Roland Morris Disability Questionnaire) and clinical tests, such as the Deep Muscle Contraction (DMC) scale, Clinical Test of Thoracolumbar Dissociation (CTTD), and Passive Lumbar Extension (PLE) test. Univariate and multivariate linear regression models were used in the prediction analysis. ResultsMean changes in pain intensity and disability following the 8-week stabilization program were −3.8 (95% confidence interval [CI], −3.2 to −4.4) and −7.4 (95% CI, −6.3 to −8.5), respectively. Clinical test scores taken at baseline did not predict changes in pain and disability at 8-week follow-up. ConclusionOur findings revealed that the DMC scale, CTTD, PLE test, clinical tests used to assess motor control dysfunction, do not predict improvements in pain and disability in patients with chronic nonspecific LBP following an 8-week lumbar stabilization exercise program.

Lumbar rocking test: A new clinical test for predicting lumbar instability.

Purpose:Significant number of low back pain is caused by spinal instability. Clinical and radiological tests are used to diagnose lumbar instability, but the practical utility of clinical tests has not been studied extensively. Hence, it was decided to study lumbar rocking test and passive lumbar extension (PLE) clinical tests to identify their accuracy for lumbar instability, in comparison to the radiological assessment.Materials and Methods:This cross-sectional prospective study was conducted in 2017 at an Indian tertiary care center, after Ethics Committee approval. No financial transection involved anywhere at any stage of the study. Patients of 30–65 years having low back pain were included following informed consent. Clinical tests conducted were rocking test and PLE tests. All patients were subjected to a neutral anteroposterior, lateral and flexion-extension X-rays of lumbosacral spine. The association between clinical tests and lumbar instability was represented by Chi-square analysis. The rest of the findings were represented as descriptive statistics.Results:Fifty patients enrolled in the study, of which 28 (56%) were females. On X-rays, the maximum angular rotation and sagittal translation were seen at L5–S1 level. 35 (70%) and 46 (92%) patients showed positive PLE and rocking test, respectively. Significant association (P < 0.05) was seen between rocking test and lumbar instability. The sensitivity of rocking test was 95.56% and positive predictive value as 93.47%.Conclusion:Clinical tests can be used effectively for the diagnosis of lumbar spine instability. Rocking test was found to be accurate and sensitive for detecting subtle lumbar instability.

Diagnostic efficacy of clinical tests for lumbar spinal instability.

Background:Although various clinical tests are utilized to assess lumbar spine instability (LSI), few have documented diagnostic efficacy. We assessed the diagnostic efficacy of four clinical and one radiographic test for LSI in patients with degenerative lumbar disease.Methods:A cohort of 52 patients with pain attributed to lumbar spine stenosis and degenerative spondylolisthesis were prospectively evaluated utilizing dynamic X-rays, the passive lumbar extension (PLE) test, instability catch sign, painful catch sign, and the apprehension sign. The results of these preoperative tests were compared with spinal surgeons’ intraoperative documentation of spinal instability considered in this study as the “gold” standard.Results:Intraoperatively, 33 patients demonstrated instability (63.5%) whereas 28 had motion documented on preoperative dynamic radiography. The sensitivity, specificity, positive, and negative predictive value and accuracy of dynamic radiography were 84.8%, 100%, 100%, 79.1%, and 90.4%, respectively. The diagnostic efficiency of PLE was higher than other additional studies – sensitivity 78.8%, specificity 94.7%, positive predictive value 96.3%, negative predictive value 72%, and accuracy rate 84.6%.Conclusion:Dynamic radiography was more reliable than any of the clinical tests in diagnosing LSI. Among the latter, PLE had the highest diagnostic value for establishing LSI.

Assessment of Lumbar Spine Height Following Sustained Lumbar Extension Posture: Comparison Between Musculoskeletal Ultrasonography and Stadiometry

ObjectivesThe purpose of this study was to correlate sitting height measured by stadiometry with lumbar spine height (LSH) modifications measured by musculoskeletal ultrasonography (MSU). MethodsEighteen healthy young adults were recruited for this study (mean age: 21.5 ± 1.5 years). All subjects were tested in the following sequence: (1) lying supine for 10 minutes, (2) sitting under loaded (9.5 kg) and unloaded conditions for 5 minutes each, (3) lying supine for 15 minutes with passive lumbar extension, and (4) sitting unloaded for 5 minutes. Both stadiometry and MSU measurements were taken after each step of the testing sequence. ResultsFollowing the loaded sitting step, sitting height (measured by stadiometry) decreased by 3.4 ± 1.6 mm, whereas following sustained lumbar extension, sitting height increased by 5.4 ± 3.5 mm (P < .05). Following loaded sitting and sustained lumbar extension, LSH decreased by 3.8 ± 1.7 mm and increased by 6.2 ± 4.1 mm, respectively (P < .05). On the basis of the mean differences (between the different steps of the testing sequence), the mean correlation coefficient and the mean coefficient of determination between stadiometry and MSU measurements were calculated at 0.93 ± 0.07 and 0.88 ± 0.13, respectively, and no statistical differences were observed (P > .05). ConclusionsIn vivo measurements of sitting height changes, measured using stadiometry, were strongly correlated with LSH changes, measured using ultrasonography.

The Relationship Between Clinical Instability and Endurance Tests, Pain, and Disability in Nonspecific Low Back Pain

ObjectiveThe aims of this study were (1) to investigate the relationship between clinical tests detecting spinal instability and the perceived pain and disability in nonspecific low back pain and (2) to investigate the relationship between endurance and instability tests. MethodsFour instability tests (aberrant movements, active straight leg raising, prone instability test, and passive lumbar extension test) and 2 endurance tests (prone bridge test [PBT] and supine bridge test [SBT]) were performed on 101 participants. Their results were compared with the Numerical Rating Scale and the Oswestry Disability Index evaluating pain and disability, respectively. ResultsA low to moderate significant relationship between pain, disability, and all tests with the exception of PBT was observed. A low to moderate significant relationship between endurance tests and instability tests was also shown. The results of PBT and SBT were significantly related to the duration of symptoms (P = .0014 and P = .0203, respectively). ConclusionThe results of endurance and instability tests appear to be related to the amount of pain and the disability in nonspecific low back pain. The persistence of pain significantly reduces anterior and posterior core muscle endurance.

A literature review of clinical tests for lumbar instability in low back pain: validity and applicability in clinical practice.

BackgroundSeveral clinical tests have been proposed on low back pain (LBP), but their usefulness in detecting lumbar instability is not yet clear. The objective of this literature review was to investigate the clinical validity of the main clinical tests used for the diagnosis of lumbar instability in individuals with LBP and to verify their applicability in everyday clinical practice.MethodsWe searched studies of the accuracy and/or reliability of Prone Instability Test (PIT), Passive Lumbar Extension Test (PLE), Aberrant Movements Pattern (AMP), Posterior Shear Test (PST), Active Straight Leg Raise Test (ASLR) and Prone and Supine Bridge Tests (PB and SB) in Medline, Embase, Cinahl, PubMed, and Scopus databases. Only the studies in which each test was investigated by at least one study concerning both the accuracy and the reliability were considered eligible. The quality of the studies was evaluated by QUADAS and QAREL scales.ResultsSix papers considering 333 LBP patients were included. The PLE was the most accurate and informative clinical test, with high sensitivity (0.84, 95% CI: 0.69 - 0.91) and high specificity (0.90, 95% CI: 0.85 -0.97).The diagnostic accuracy of AMP depends on each singular test. The PIT and the PST demonstrated by fair to moderate sensitivity and specificity [PIT sensitivity = 0.71 (95% CI: 0.51 - 0.83), PIT specificity = 0.57 (95% CI: 039 - 0.78); PST sensitivity = 0.50 (95% CI: 0.41 - 0.76), PST specificity = 0.48 (95% CI: 0.22 - 0.58)].The PLE showed a good reliability (k = 0.76), but this result comes from a single study. The inter-rater reliability of the PIT ranged by slight (k = 0.10 and 0.04), to good (k = 0.87).The inter-rater reliability of the AMP ranged by slight (k = −0.07) to moderate (k = 0.64), whereas the inter-rater reliability of the PST was fair (k = 0.27).ConclusionsThe data from the studies provided information on the methods used and suggest that PLE is the most appropriate tests to detect lumbar instability in specific LBP. However, due to the lack of available papers on other lumbar conditions, these findings should be confirmed with studies on non-specific LBP patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-015-0058-7) contains supplementary material, which is available to authorized users.

The inter-rater reliability of clinical tests that best predict the subclassification of lumbar segmental instability: structural, functional and combined instability

Objectives:This study investigated the inter-rater reliability of three structural end range lumbar segmental instability tests with the highest positive likelihood ratio (+ LR) against flexion–extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilisation exercises in patients with recurrent or chronic low-back pain (R/CLBP). The study also investigated the reliability of lumbar segmental instability, subclassification as: functional, structural and combined instability.Method:Forty adults with R/CLBP (30 men and 10 women), aged 21–71 years, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability.Results:All functional-instability tests: the prone instability test (PIT), the aberrant motion test and the average passive straight-leg raise (PSLR>91°) test showed a high percentage agreement (90, 97·5 and 95%, respectively) and a high kappa coefficient (0·71, 0·79 and 0·77, respectively). In addition, two structural tests: the lumbar flexion range of motion (ROM) >53° and the passive lumbar extension test (PLET) showed a high percentage agreement (82 and 73%, respectively), and a moderate kappa coefficient (0·48 and 0·46, respectively). The lack of hypomobility with the posteroanterior (PA) glide test was found to be unreliable (agreement = 25%; k = − 0·02). Locating the pain-provoking segment, as the first portion of PIT, was found to be moderately reliable (k = 0·41). The subclassification categories of lumbar segmental instability (functional, structural and combined) were found to be significantly reliable (PABAK) 0·90, 0·70 and 0·95, respectively).Discussion:All investigated tests (except the lack of hypomobility with the PA glide test), in addition to subclassifying the categories of lumbar segmental instability, were significantly reliable in the assessment of lumbar instability.

Pain, Disability, and Diagnostic Accuracy of Clinical Instability and Endurance Tests in Subjects With Lumbar Spondylolisthesis

ObjectiveThe aims of this study were (1) to investigate the relationship between the main clinical tests to detect spinal instability, the perceived pain and disability, and symptomatic spondylolisthesis (SPL) characteristics, (2) to investigate the relationship between endurance and instability tests, and (3) to measure the diagnostic accuracy of these tests in unstable SPL diagnosed against dynamic radiographs. MethodsFour instability tests were evaluated on 119 subjects: aberrant movements, active straight leg raising (ASLR), prone instability test, and passive lumbar extension test (PLE); and 2 endurance tests, prone bridge test and supine bridge test (SBT). The results were compared with the numeric rating scale for pain and the Oswestry Disability Index for disability. These tests were used as index tests and compared with dynamic radiographs as reference standard on 64 subjects. ResultsA significant relationship between disability and all the clinical tests but ASLR was observed. The relation between tests and pain was weaker, not significant for prone instability test and aberrant movement and critical for ASLR (P = .05). There was a low relationship between endurance tests and instability tests. Only PLE showed a significant association with dynamic radiographs (P = .017). ConclusionEndurance and instability tests appear to be weakly related to the amount of pain but significantly related to the disability in symptomatic SPL. Of the tests evaluated, PLE exhibited the best ability to predict positive dynamic radiographs.

The Interrater Reliability of Physical Examination Tests That May Predict the Outcome or Suggest the Need for Lumbar Stabilization Exercises

Interrater reliability. (1) To examine the interrater reliability of an existing clinical prediction rule (CPR) to predict the success of lumbar stabilization exercises (LSE), and (2) to examine the interrater reliability of 4 clinical tests that may be useful in determining the need for LSE. Physical therapists commonly use LSE to manage patients with low back pain. The clinical efficacy of LSE is unclear. A CPR has been previously suggested to identify patients most likely to benefit from LSE. The passive lumbar extension test, lumbar extension load test, active straight leg raise test, and active hip abduction test are 4 clinical tests that may also suggest the need for LSE. The reliability of these tests has not been established sufficiently. Thirty patients with low back pain, who participated in a larger randomized clinical trial, underwent all tests by 2 independent examiners. Kappa coefficients with 95% confidence intervals (CIs) were calculated to establish the interrater reliability of the CPR and individual tests. The interrater reliability of the CPR was excellent (κ = 0.86; 95% CI: 0.65, 1.00). The interrater reliability of the individual items making up the CPR, as well as that of the passive lumbar extension test, was substantial (κ = 0.64-0.73 and κ = 0.76, respectively; 95% CI: 0.46, 1.00). The interrater reliability of the active straight leg raise test (κ = 0.53; 95% CI: 0.20, 0.84) and lumbar extension load test (κ = 0.47; 95% CI: 0.14, 0.78) was moderate. The interrater reliability of the active hip abduction test was poor (κ = -0.09; 95% CI; -0.35, 0.27). With the exception of the active hip abduction test, all other clinical tests can be considered sufficiently reliable for clinical use. The relatively small sample size likely contributed to the fairly wide confidence intervals around some of the reliability indices.

Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis

ObjectiveSpondylolisthesis is a pathological condition characterized by the slipping of a vertebral body, compared with the underlying one, following structural and/or degenerative changes of the spine. The purpose of this case series is to describe clinical presentations and the conservative physiotherapy management of 4 patients with low back pain and lumbar isthmic spondylolisthesis. Clinical FeaturesFour patients aged 25, 43, 36, and 50 years presented with low back pain of various duration. Radiographs confirmed the presence of lumbar isthmic spondylolisthesis. Outcome measures included numerical rating scale, disability outcome measure (Oswestry Disability Index), spinal instability tests (Prone Instability Test, Passive Lumbar Extension test), and muscle function tests (Aberrant Movement Patterns, Active Straight Leg Raising, Prone and Supine Bridge Tests). Intervention and OutcomesTreatment consisted of postural reeducation, stretching, and strengthening exercises. Over the course of individualized treatment, ranging from 8 to 10 treatment visits, outcomes improved for all 4 patients. ConclusionThis report describes varying clinical presentations and treatment of 4 patients with isthmic spondylolisthesis, suggesting that different pain generators could be managed by different conservative approaches.

Clinical Tests to Diagnose Lumbar Segmental Instability: A Systematic Review

Systematic literature review. To evaluate the diagnostic accuracy of clinical tests used to diagnose patients with structural lumbar segmental instability (LSI). Patients with structural LSI represent an important, identifiable subgrouping of individuals with low back pain. Numerous clinical tests have been proposed to diagnose structural LSI; however, data on the diagnostic accuracy of these tests have not yet been evaluated through a systematic review of the literature. A systematic review was conducted in 6 electronic databases for diagnostic accuracy studies, published between January 1950 and March 2010, that evaluated clinical tests against radiological diagnosis of structural LSI. The diagnostic accuracy of the clinical tests from the retrieved articles was independently evaluated, reviewed, and quality scored using the QUADAS tool. Four articles and a total of 11 clinical tests used in the diagnosis of structural LSI met the study inclusion criteria. The majority of tests had high specificity but low sensitivity, with positive likelihood ratios ranging from very small to moderate. QUADAS scores ranged from 16 to 25 out of a possible 26. The passive lumbar extension test was the most accurate clinical test, with high sensitivity (84%), specificity (90%), and a positive likelihood ratio of 8.8 (95% CI: 4.5, 17.3), indicating that this clinical test may be useful in the differential diagnosis of structural LSI. This systematic review found that the majority of clinical tests routinely employed to diagnose structural LSI demonstrated only limited ability to do so. The results do, however, indicate that the passive lumbar extension test may be useful in orthopaedic clinical practice to diagnose structural LSI. Additional research is required to further validate its use for diagnosing structural LSI in all populations of those with low back pain. Diagnosis, level 2a.