Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism

O’Sullivan, Peter

doi:10.1016/j.math.2005.07.001

Cited by 818 publications

(733 citation statements)

References 34 publications

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“…There are multiple hypotheses for this observation. AEP individuals subjectively report extension-related activities as pain provocative due to a reduced capacity to control extension movement [5]. Therefore, the functional tasks may not have challenged the spine into substantial extension to elicit pain and maladaptive movement control.…”

Section: Discussionmentioning

confidence: 99%

“…A multidimensional classification system (MDCS), which considers such mechanisms, for example, maladaptive motor control Electronic supplementary material The online version of this article (doi:10.1007/s00586-017-5217-1) contains supplementary material, which is available to authorized users. impairment (MCI) (characterised by pain provocative behaviours), has been proposed [5].…”

Section: Introductionmentioning

confidence: 99%

“…This MDCS [5] outlines five NSCLBP MCI subgroups, where individuals are proposed to display full range of movement (ROM) in the direction of pain provocation and are clinically observed to habitually adopt end-range postures. These MCI subgroups are based upon subjective reporting of direction-specific aggravating and easing factors (described elsewhere [6]).…”

Section: Introductionmentioning

confidence: 99%

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Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

et al. 2017

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Purpose A multidimensional classification approach suggests that motor control impairment subgroups exist in non-specific chronic low back pain (NSCLBP). Differences in sitting lumbar posture have been identified between two such subgroups [flexion pattern (FP) and active extension pattern (AEP)] and healthy individuals; however, functional spinal movement has not been explored. This study will evaluate whether NSCLBP subgroups exhibit regional spinal kinematic differences, compared to healthy individuals, during functional tasks. Methods Observational, cross-sectional study design. Spinal kinematics of 50 NSCLBP subjects (27 FP, 23 AEP) and 28 healthy individuals were investigated using 3D motion analysis (Vicon TM ) during functional tasks [reaching upwards, step down, step up, lifting, and replacing a box, stand-to-sit, sit-to-stand, bending to retrieve (and returning from retrieving) a pen from the floor]. Mean sagittal angle for the total thoracic, total lumbar, upper thoracic, lower thoracic, upper lumbar, and lower lumbar regions between groups was compared. Results Significant differences were observed in lower thoracic and upper lumbar regions between NSCLBP subgroups during most tasks. Significant differences were observed between the FP and healthy group in the lower thoracic region during stand-to-sit-to-stand tasks and bending (and returning from) to retrieve a pen from the floor. All significant results demonstrated the FP group to operate in comparatively greater flexion. Conclusions The thoraco-lumbar spine discriminated between FP and AEP, and FP and healthy groups during functional tasks. FP individuals demonstrated more kyphotic thoraco-lumbar postures, which may be pain provocative. No significant differences were observed between AEP and healthy groups, suggesting that alternative mechanisms may occur in AEP.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

et al. 2017

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“…This is as a result of a complete subjective and physical evaluation that identified the patient's experience of pain, its behaviour, functional impairments, beliefs, coping, pain-related fear and distress. The examination involves analysis of the functional impairments reported by the patient to determine if the movement and pain behaviours are adaptive (protective) or maladaptive (provocative) (Elvey and O'Sullivan, 2004;O'Sullivan, 2004O'Sullivan, , 2005.…”

Section: Discussionmentioning

confidence: 99%

“…'Diagnostics' places a strong emphasis on the correlation between the subjective history, radiology, pain behaviour, lifestyle factors, physical examination findings (examining the articular, neural and motor control systems) and screens for serious pathology ('red flags') and dominant psycho-social factors (including negative beliefs, coping, fear avoidance beliefs, stress, anxiety, depression, catastrophising etc). As a result of this diagnostic process the relationship between the patient's pain and the MCI is determined (Elvey and O'Sullivan, 2004;O'Sullivan, 2005). Where it is determined that the MCI is directly related to the provocation of the pain disorder, a classification of MCI with respect to the direction of pain provocation is made.…”

Section: O'sullivan's Classification System (Cs) For a Sub-group Of Nmentioning

confidence: 99%

The validity of O’Sullivan’s classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI): Overview of a series of studies and review of the literature

Dankaerts

O’Sullivan

2011

Manual Therapy

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a b s t r a c tChronic Low Back Pain (LBP) remains a common, recalcitrant and costly problem for the individual sufferer and for society. Effective treatments that reduce the social and economic burden have yet to be established for the majority of chronic LBP cases. Lack of evidence for specific interventions has been blamed on the heterogeneity of the chronic LBP population as well as a lack of a patient centred biopsycho-social approach. This issue of heterogeneity has resulted in classification being considered the highest research priority in the area of chronic LBP. The potential for a 'wash-out effect' caused by the heterogeneity of the chronic LBP populations sampled for randomised controlled clinical trials (RCTs), has driven the need for classifying patients with nonspecific chronic LBP. A summary of a series of studies is outlined in this review paper. They represent a comprehensive investigation into the validity of O'Sullivan's proposed mechanism-based classification system (CS) for a sub-group of localized mechanically provoked nonspecific chronic LBP with motor control impairment (MCI). Further, the findings of these studies are discussed in relation to the relevant literature and the clinical implications arising are presented. Finally, the limitations of this research are outlined and recommendations for future research are made.

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Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain

Odebiyi

Ferreira

Tella

2013

Cochrane Database of Systematic Reviews

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Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism

Cited by 818 publications

References 34 publications

Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

Non-specific chronic low back pain: differences in spinal kinematics in subgroups during functional tasks

The validity of O’Sullivan’s classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI): Overview of a series of studies and review of the literature

Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain

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