Movement System Classifications in LBP

Question 1

What are 5 movement differences during functional activities in those with LBP?

Answer 1

(1) earlier lumbopelvic rotation during active knee extension in sitting
(2) earlier lumbopelvic rotation during knee extension in prone
(3) aberrant movement commonly seen during lumbar flexion (i.e. slower, less ROM, delayed pelvic movement, greater lumbar extensor activation, and increased stiffness)
(4) decreased variability during running and bending
(5) increased variability during reaching, gait, and sit to stand

Question 2

What movement differences during functional activities for those with LBP would occur as a “protective response”?

Answer 2

Decreased variability during running and bending

Question 3

What movement differences during functional activities for those with LBP would occur as a “motor control deficits”?

Answer 3

Increased variability during reaching, gait, and sit to stand

Question 4

During what activities do identified LBP movement impairments become apparent? (6)

Answer 4

(1) “waiters bow” standing hip flexion
(2) pelvic tilt in standing
(3) one leg stance
(4) sitting knee extension
(5) quadruped forward/backward rocking
(6) prone lying active knee flexion

Question 5

What 3 aberrant movements can occur with someone with LBP?

Answer 5

(1) lumbopelvic reversal
(2) Gowers sign
(3) favoring one side during flexion

Question 6

In those with non-specific LBP, do (1) movement changes lead to changes in pain (2) pain or activity changes relate to movement changes?

Answer 6

(1) Yes, increased spine ROM, velocity, flexion relaxation of back extensors related to decreased pain and less activity limitation
(2) No, in the majority of people with LBP, changes in pain or activity are unrelated to changes in movement

Question 7

Does movement NEED to change for LBP to improve or for impairments to improve?

Answer 7

NO, not necessarily!

Question 8

What is the underlying premise of Sahrmann’s movement system impairment classification?

Answer 8

The majority of spinal dysfunctions are the result of cumulative microtrauma associated with faulty: alignment, stabilization, and movement patterns. Areas of relative excessive flexibility become the problem.

Question 9

How is treatment directed and what does it involve in Sahrmann’s movement system impairment classification?

Answer 9

It is directed toward correcting movements in the offending direction. It involves modifying direction-specific movement and educating about modifying functional activities.

Question 10

What are the 5 classifications for Sahrmann’s movement system impairment classification?

Answer 10

(1) flexion
(2) extension
(3) rotation
(4) rotation with flexion
(5) rotation with extension

Question 11

What are the characteristics and contributing factors for the 5 classifications for Sahrmann’s movement system impairment classification?

Answer 11

(1) flexion: increase symptoms with flexion
(2) extension: increase symptoms with extension
(3) rotation: increase symptoms with SB/Rotation
(4) rotation with flexion: increase symptoms with rotation and flexion
(5) rotation with extension: increase symptoms with rotation and extension

Contributing Factors: axial loading and sacroiliac joint pain

Question 12

What are the 4 classifications in the O’Sullican movement system impairment classification?

Answer 12

(1) flexion pattern (control or movement impairment)
(2) extension pattern
(3) lateral shift pattern
(4) multi-directional pattern

Question 13

What is the treatment for the O’Sullican movement system impairment classification?

Answer 13

Motor control strategies to retrain specific stabilizing muscles, breathing, and functional movement patterns

Question 14

What may be the characteristics of O’Sullivans flexion pattern: control impairment?

Answer 14

• impairment in the control of the painful segment in direction of pain
• loss of functional control in neutral zone
• repetitive strain and excessive loading
• painful arc or pain in variety of directions
• movement and postures adopted worsen symptoms
• decreased proprioceptive awareness
• fear of movement and anxiety
• peripherally and/or centrally mediated pain
• mal-adaptive

Question 15

What might be the exam findings of O’Sullivan’s flexion pattern: control impairment?

Answer 15

• unable to dissociate LE movement from lumbopelvic region
• lumbar segmental hypermobility
• positive prone instability test
• weak hip abductors
• may present with sustained lumbar extension with or without sidebend in standing

Question 16

What are the characteristics of O’Sullivan’s flexion pattern: movement impairment?

Answer 16

• painful loss of movement in at least one direction
• high levels of muscle guarding and co-contraction
• excessive stability
• fear of moving, hyper-vigilance, anxiety
• continued peripheral nociceptor sensitization
• mal-adaptive

Question 17

What might be exam findings in O’Sullivan’s flexion pattern: movement impairment?

Answer 17

• co-contraction of trunk muscles at rest and with all functional movements
• limited potentially painful ROM in all directions
• lumbar segmental hypomobility
• belief that stabilization is necessary for all movements
• hip flexor stiffness

Question 18

Why is education about movement important? (3)

Answer 18

(1) lowers fear
(2) increases load tolerance
(3) increases function