Multidirectional Instability of the Lumbar Spine
Signs
Clinical Presentation
Subjective
- “Patients describe their provocative movements as being multi-directional in nature (Fig. 11). All weight bearing postures are painful and diÅculty is reported in obtaining relieving positions during weight bearing”2
- “Locking of the spine is commonly reported following sustained flexion, rotation and extension postures”2
Posture
- “These patients may assume a Øexed, extended or laterally shifted spinal posture”2
Pain
“Excessive segmental shifting and hinging patterns may be observed in all movement directions with `jabbing’ pain and associated back muscle spasm.”2
Overuse of Global spine stabilizers
- “These patients have great diÅculty assuming neutral lordotic spinal positions, and attempts to facilitate lumbar multiÆdus and transversus abdominis co-contraction (especially during weight bearing positions) are usually associated with a tendency to Øex, extend or laterally shift the spine segmentally, with associated global muscle substitution, bracing of the abdominal wall and pain.”2
Palpation
- Hypomobility at the symptomatic level
- “Palpatory examination reveals multi-directional increased intersegmental motion at the symptomatic level.”2
ROM
- Normal PROM
- Abnormal AROM
Examination
- Reflex Testing
Joint Mobility
- Manually assess joint mobility
Special Tests
Prognosis
“If these patients present with high levels of irritability and an inability to tolerate compressive loading in any position, they have a poor prognosis for conservative exercise management.”2
Rehabilitation
1.
Perkins N. Stretch Affect Clinical Internship. Published online 10-14-24.
2.
O’Sullivan PB. Masterclass. Lumbar segmental “instability”: Clinical presentation and specific stabilizing exercise management. Manual Therapy. 2000;5(1):2-12. doi:10.1054/math.1999.0213
3.
Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.
Citation
For attribution, please cite this work as:
Yomogida N, Kerstein C. Multidirectional
Instability of the Lumbar Spine. https://yomokerst.com/The
Archive/Pathologies/Pathologies by Region/Trunk/Lumbar
spine/multidirectional_lumbar_spine_instability.html