Masterclass. Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise management

O’Sullivan, Peter

doi:10.1054/math.1999.0213

Cited by 460 publications

(393 citation statements)

References 36 publications

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“…Lumbar fusion is presumed to be the surgical treatment of choice for individuals with LBP due to instability [52], while non-surgical management has focused on stabilization exercises [27,29,43]. Research evidence suggests that patients with instability may respond better to these treatments than alternative approaches [10,26,42,62,63].…”

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confidence: 99%

Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

2005

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Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

2005

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“…Training LM and TrA, while maintaining lumbar lordosis and thoracic kyphosis, is an element of specific motor control exercise (Hides et al, 2008b;O'Sullivan, 2000). FRED exercise has already been shown to automatically recruit LM and…”

Section: Discussionmentioning

confidence: 99%

“…It involves progressive training, beginning with isolating muscle recruitment, followed by recruitment during upright, functional positions while maintaining lumbar lordosis and thoracic kyphosis (Hides et al, 2008b;O'Sullivan, 2000). This requires conscious effort by the patient in order to recruit LM and TrA deliberately and develop or maintain the required posture.…”

Section: Introductionmentioning

confidence: 99%

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

Winnard

Debuse

Wilkinson

et al. 2017

Musculoskeletal Science and Practice

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BackgroundDysfunction of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles is associated with low back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) has shown potential as a non-specific LBP intervention by automatically recruiting LM and TrA. Loss or lordosis and altered lumbopelvic positioning has also been linked to LBP and is often trained within LM and TrA interventions. The effect that FRED exercise has on lumbopelvic positioning and lumbar lordosis is unknown. ObjectivesTo assess the effect of FRED exercise on lumbopelvic kinematics and alignment to establish whether FRED exercise promotes a favourable lumbopelvic posture for training LM and TrA. DesignWithin and between-group comparison study MethodOne hundred and thirty participants, 74 experiencing LBP, had lumbopelvic kinematic data measured during over-ground walking and FRED exercise.Magnitude-based inferences were used to compare walking with FRED exercise within participants and between the asymptomatic and LBP groups, to establish the effects of FRED exercise on lumbopelvic kinematics, compared to walking, in each group. ResultsFRED exercise promotes an immediate change in anterior pelvic tilt by 8.7 degrees compared to walking in the no-LBP and LBP groups. Sagittal-plane spinal extension increased during FRED exercise at all spinal levels by 0.9 degrees in the no-LBP group, and by 1.2 degrees in the LBP group. ConclusionsFRED exercise promotes a lumbopelvic position more conducive to LM and TrA training than walking in both asymptomatic people and those with LBP. Highlights A posture conducive to LM and TrA training was promoted. The posture appears to occur automatically in people with and without LBP. Exercise on the FRED may be effective for LM and TrA training.

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“…These exercise programs are composed of specific exercises aimed at improving motor performance of the spinal muscles composing the local subsystem, including the transversus abdominis, multifidus, and internal oblique. 29,30,34,35 Motor control deficits, muscular atrophy, and fatigue of the transversus abdominis and multifidus muscles have been associated with LBP. 17,19 Multiple studies and systematic reviews (SRs) regarding the effectiveness of lumbar stabilization exercises in addressing these dysfunctions in people with chronic LBP have been published.…”

Section: T T Conclusion: This Review Of Srs Identifiedmentioning

confidence: 99%

“…32 Although there is no general consensus regarding the most effective treatment for LBP, it has been suggested that exercise, specifically lumbar stabilization, may be effective in reducing the impairments, activity limitations, and participation restrictions associated with chronic LBP. 26,29,32 Segmental lumbar stabilization exercises are based on theories proposed by Panjabi 31 and Bergmark. 4 Panjabi 31 hypothesized that the spinal stabilizing system is composed of active, passive, and neural subsystems.…”

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confidence: 99%

Quality of Systematic Reviews on Specific Spinal Stabilization Exercise for Chronic Low Back Pain

Haladay¹,

Miller

Challis

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Systematic literature review. Objective To evaluate the quality of systematic reviews (SRs) on specific stabilization exercises for chronic low back pain (LBP). Background Multiple SRs regarding the effectiveness of lumbar stabilization exercises for people with chronic LBP have been published. As more SRs are published, the more it is recognized that, like other forms of research, methodological quality affects the validity of, and conclusions drawn from, the data. Methods A search of MEDLINE, CINAHL, and Embase was completed. Additionally, the PEDro database was screened and hand searching was completed. Included SRs had to contain randomized controlled trials examining a specific stabilization exercise program for the treatment of chronic LBP. Additionally, the assessed outcome measures had to include pain and/or disability measures. Literature reviews and clinical practice guidelines were excluded. Three reviewers independently assessed each SR for methodological quality. Results The search produced 665 SRs for review, of which 8 fulfilled the inclusion criteria. Consensus quality assessment scores ranged from 13/26 to 26/26, with an average of 20.7 points. Percent agreement and kappa values for individual criteria scores ranged from 50% to 92% and 0.25 to 0.85, respectively. Agreement was moderate to substantial across individual items, except for criterion 1. The intraclass correlation coefficient for overall score was 0.98 (95% confidence interval: 0.96, 0.99). Conclusion This review of SRs identified several high-quality reviews that indicated some benefit of specific stabilization exercise programs for patients with nonspecific chronic LBP. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2013;43(4):242–250. Epub 14 January 2013. doi:10.2519/jospt.2013.4346

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Masterclass. Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise management

Cited by 460 publications

References 36 publications

Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

Quality of Systematic Reviews on Specific Spinal Stabilization Exercise for Chronic Low Back Pain

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