Multidirectional Instability of the Lumbar Spine

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

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.