Multidirectional Instability of the Lumbar Spine

Authors
Affiliations

Doctor of Physical Therapy

B.S. in Kinesiology

Doctor of Physical Therapy

B.A. in Neuroscience

Signs

  • Gower’s sign1
  • “juttering” during extension1
  • Step sign (where the unstable segment noticeably protrudes in standing, creating a step, but there is no step in prone)1

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

  • (+) Prone Instability3
  • Anterior STability Test3
  • LAteral STability Test3
  • Passive Lumbar Extension Test3

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

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