Low back pain treatment groups based on non-pathoanatomic model
Prevalence of low back pain is estimated up to 80% of the population will experience some form of low back pain in their lives
Most will have complete resolution not requiring intervention
Between 10% and 30% will have chronic symptoms (greater than 3 months)
Up to 5% of people with low back pain will become disabled
Largest predictor of low back pain is presence of a previous episode
Using non-anatomic model for diagnosis in non-specific low back pain
mechanical evaluation rather than trying to find specific anatomical culprit can
be more effective in diagnosis
based on separating patients into syndromes or treatment groups
whether treatment is effective based on a change in the comparable sign
worsen or peripheralize with prolonged or repeated flexion
improve or centralize with prolonged or repeated extension
- Treatment includes end-range
extension, education on avoidance of flexion. Patients may benefit from
older age (>50 years)
worsen with prolonged or repeated extension
improve with prolonged or repeated flexion
evidence of lumbar spinal stenosis
- Treatment includes exercise to
address flexibility, strength. Patients may benefit from mobilization, body
weight supported ambulation
flexion and extension worsen symptoms
glide motion relieves or centralizes symptoms
may have visible frontal plane deformity (lateral deviation of shoulder girdle
relative to pelvis in standing)
- Treatment includes correction of
lateral shift deformity, end-range side glide
of symptoms < 16 days ago
Avoidance Belief Questionnaire Work Subscale score < 19
symptoms distal to the knee
or more hypomobile segments in lumbar spine
internal rotation range of motion > 35° at least one side
- Treatment includes manipulation of
lumbar spine, active range of motion exercise
younger age (<40 years)
catch reported on motion testing in sagittal plane
prone instability test
- Treatment includes progression from
individual activation of deep stabilizing muscles to co-contraction of flexors
and extensors, static to dynamic movements, unloaded to loaded exercise
of nerve root compression
movement decreases or centralizes symptoms
- Treatment focuses on auto traction or
mechanical traction recommended in prone position
Therex Portal lists exercises to treat low back pain into treatment groups based on 1) Directional Preference 2) Mobility Deficit and 3) Movement Coordination Deficit. Here is an example of flexion-based exercise and an extension-based exercise.
Extension Based Exercise
Flexion Based Exercise
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Author- Kris Heintzelman PT, DPT, OCS.