Lumbar functional instability: a critical appraisal of the literature

Demoulin, Christophe; Distree, Vincent; Tomasella, Marco; Crielaard, Jean-Michel; Vanderthommen, Marc

doi:10.1016/j.annrmp.2007.05.007

Cited by 60 publications

(43 citation statements)

References 97 publications

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“…7 Under the influence of biomechanical imbalance caused by the accumulation of fat in the abdomen (central obesity), muscle atrophy can occur, associated with delayed activation of the stabilizing muscles of the spine, thus contributing to the onset of lumbar instability in the obese individual. 8 The thought that there may be changes in the sagittal balance of these patients is valid when thinking about these changes in obese patients. Mainly because it is still a topic that is unknown to the vast majority of orthopedic doctors and even specialists in diseases of the spine.…”

Section: Introductionmentioning

confidence: 99%

Avaliação angular do equilíbrio sagital em pacientes obesos

et al. 2013

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Objectives: Given the small amount of information regarding the pathological and degenerative changes of the spine, this study was carried out in order to evaluate and quantify the angular values of sagittal balance in the obese population. Methods: We measured the angles of pelvic incidence (PI), pelvic version (PV) and sacral slope (SS). Results: We evaluated 30 patients, 19 females and 11 males, in 2012, who were to be submitted tobariatric surgery. The mean age was 33 years old. The mean BMI was 41 kg/m2, the mean value for men being 43 kg/ m2 and 39 kg/m2 for women. The mean PI was 57°. The PV was 19°. The DS was 38°. The value of pelvic incidence and pelvic version was on average higher than those found in people with normal body mass index. Regarding the sacral slope the value were the same of those of the normal population. Conclusions: Increasingly the sagittal balance has gained importance in the evaluation of the spine. It is necessary further literature and increasing medical knowledge of diseases and comorbidities that may alter sagittal balance in patients, such as obesity.Keywords: Obesity; Postural balance; Posture; Pelvis; Body mass index. RESUMO Objetivo: Tendo em vista a pouca quantidade de informações a respeito das alterações degenerativas e patológicas da coluna vertebral realizou-se este estudo com objetivo de avaliar e quantificar os valores angulares do equilíbrio sagital na população obesa. Métodos: Foram medidos os ângulos de incidência pélvica (IP), versão pélvica (VP) e declive sacral (DS

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Section: Introductionmentioning

confidence: 99%

Avaliação angular do equilíbrio sagital em pacientes obesos

et al. 2013

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“…7,8,14,15 However, there is no diagnostic standard to quantify the functional instability around the neutral position. 6,8,15 A number of studies have attributed this functional instability to the lack of neuromuscular control of the joint during activities of daily living. [6][7][8]10 Hicks et al 12 studied the clinical tests that might predict the success of stabilisation exercises that have been developed to improve spinal motor control (stiffness) around the spinal neutral position.…”

Section: Introductionmentioning

confidence: 99%

“…6,8,15 A number of studies have attributed this functional instability to the lack of neuromuscular control of the joint during activities of daily living. [6][7][8]10 Hicks et al 12 studied the clinical tests that might predict the success of stabilisation exercises that have been developed to improve spinal motor control (stiffness) around the spinal neutral position. They came up with four predictors that together form the clinical prediction rule (CPR) for lumbar stabilisation exercise.…”

Section: Introductionmentioning

confidence: 99%

“…The osseoligamentous subsystem limits segmental motion at the extremes of lumbar motion. [6][7][8] The loss of neuromotor capability to control segmental movement during mid-range is defined as functional instability, 7 whereas the disruption of passive stabilisers, which limit the excessive segmental end range of motion (ROM), is defined as structural instability. 7,9 Panjabi 10,11 suggests that a loss of integrity within the passive subsystem may make segments unstable unless the neuromuscular subsystem compensates for that loss.…”

Section: Introductionmentioning

confidence: 99%

“…4 Previous researches show that one of the main causes of frequently recurring LBP is lumbar segmental instability. 1,5,6 During daily living activities, two spinal subsystems are chiefly responsible for controlling and preventing excessive motion between spinal segments: the neuromotor control subsystem and the osseoligamentous subsystem. The neuromotor control subsystem controls segmental motion during the mid-range.…”

Section: Introductionmentioning

confidence: 99%

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

Alyazedi¹,

Lohman²,

Swen³

et al. 2015

Journal of Manual & Manipulative Therapy

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Objectives: This study investigated the inter-rater reliability of three structural end range lumbar segmental instability tests with the highest positive likelihood ratio ( z 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 (PSLRw91u u) 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) w53u u 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 (agreement525%; k5{0?02). Locating the pain-provoking segment, as the first portion of PIT, was found to be moderately reliable (k50?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.

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Spinal Instability in Metastatic Disease

Patt

Leas

2018

Metastatic Spine Disease

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Lumbar functional instability: a critical appraisal of the literature

Cited by 60 publications

References 97 publications

Avaliação angular do equilíbrio sagital em pacientes obesos

Avaliação angular do equilíbrio sagital em pacientes obesos

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

Spinal Instability in Metastatic Disease

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