LBP with Movement Coordination Deficits

LBP with Movement Coordination Deficits Classification

Pathoanatomic Diagnosis Related to Movement Coordination

  • ICD diagnosis includes spinal instabilities and could include spondylolisthesis, degenerative disc disease, facet joint arthropathy, and ligamentous laxity.

LBP with Movement Coordination Deficits: Subjective Report

  • Aberrant motion with spine movements such as instability catch, painful arc, or deviations from the sagittal plane.

  • Tenderness in the lumbar region, often localized to the affected segments.

  • Referred pain in the buttock and thigh, which may or may not follow a dermatomal pattern.

  • Paraspinal muscle guarding/tightness, indicative of protective muscle spasm.

  • Pain with sustained postures, particularly prolonged sitting or standing.

Clinical Findings: Movement Coordination - Acute

  • Acute exacerbation of recurring low back pain commonly associated with referred lower extremity pain.

  • Symptoms produced with initial to mid-range spinal movements and provocation of the involved lumbar segment(s).

  • Movement coordination impairments of the lumbopelvic region with low back flexion and extension movements, often presenting as jerky or uncoordinated motion.

Clinical Findings: Movement Coordination - Subacute

  • Subacute exacerbation of recurring low back pain that is commonly associated with referred lower extremity pain.

  • Symptoms produced with mid-range motions that worsen with end-range movements or positions and provocation of the involved lumbar segment(s).

  • Lumbar segmental hypermobility may be present, detectable via motion palpation.

  • Mobility deficits of the thorax and pelvic/hip regions may be present, contributing to altered movement patterns.

  • Diminished trunk or pelvic region muscle strength and endurance, assessed through specific muscle testing.

  • Movement coordination impairments while performing self-care/home management activities, such as bending, lifting, or twisting.

Clinical Findings: Movement Coordination - Chronic

  • Chronic, recurring low back pain that is commonly associated with referred lower extremity pain.

  • Presence of one or more of the following:

    • Low back and/or low back-related lower extremity pain that worsens with sustained end-range movements or positions.

    • Lumbar hypermobility with segmental motion assessment.

    • Mobility deficits of the thorax and lumbopelvic/hip regions.

    • Diminished trunk or pelvic region muscle strength and endurance.

    • Movement coordination impairments while performing community/work-related recreational or occupational activities.

Clinical Findings: Movement Coordination - Hicks et al Clinical Prediction Rule

  • Those likely to benefit from a stabilization program with 3 or more of the 4 variables = +LR 4.0.

  • Variables:

    • Age less than 41 years.

    • SLR > 91 degrees.

    • Positive prone instability test.

    • Presence of aberrant motion.

Evaluation of Movement Coordination

  • Active range of motion of the Lumbar Spine

    • Quality

    • Quantity

    • Symptom reproduction

Evaluation of Movement Coordination - Quality of Active range of motion

  • Quality: presence of ABERRANT MOTION

    • Altered lumbopelvic rhythm

    • Gower’s Sign

    • Deviation from the sagittal plane

    • Instability catch, shake, or judder

    • Painful arc of motion

Evaluation of Movement Coordination - Quantity of Active range of motion

  • Quantity:

    • Acute: pain in initial to mid ranges

    • Subacute: pain in mid to end range

    • Chronic: pain with sustained end range movements

    • Symptom reproduction: are the patient’s symptoms provoked by the ROM.

Evaluation of Movement Coordination - Inspection

  • Soft tissue appearance: muscle atrophy, hypertrophy, or asymmetry.

  • Soft tissue asymmetries: tightness, skin contour different side to side, presence of swelling or inflammation.

  • Posture: increased lordotic, or kyphotic postures; presence of scoliosis or lateral shift.

  • “Hinge” points with observation of active ROM or functional movements, indicating areas of concentrated motion or compensation.

Evaluation of Movement Coordination - Palpation

  • Bony palpation: presence of a step off with SP palpation in lumbar region, indicating spondylolisthesis or fracture.

  • Soft tissue palpation: increased tissue density, contraction, “tone” or “protective tone”, indicative of muscle guarding or spasm.

  • Soft tissue appearance: muscle atrophy, or increased firing.

Evaluation of Movement Coordination - Palpation of Passive Physiologic Intervertebral Motion

  • Hypermobile segments or groups of segments.

  • Findings of hypermobility can build a case for movement coordination deficits.

Evaluation of Movement Coordination - Passive Accessory Intervertebral Joint Mobility

  • PA pressures.

  • Unilateral PA pressures.

  • Findings of hypermobility can build a case for movement coordination deficits.

Evaluation of Movement Coordination - Muscle Performance testing

  • MMT

  • Endurance tests: - Biering-Sorensen test (trunk extensor endurance)

    • Flexor endurance test

    • Side bridge test

Evaluation of Movement Coordination - Special Testing

  • Prone Instability test

Keys of Evaluating LBP with Movement Coordination Deficits

  • Limited active and/or passive motion with symptoms of pain and can have aberrant motion.

  • Often includes LE referred pain.

  • Hicks CPR criteria for stabilization benefit:

    • Age less than 41 years

    • SLR > 91 degrees

    • Positive prone instability test

    • Presence of aberrant motion

  • Muscle performance testing shows weakness.

  • Passive mobility testing shows hypermobility.