Week 8 Lumbar Instability

Question 1

Can lumbar instability be a primary dx?

Answer 1

No but is can be a complicator

Question 2

What is the history for lumbar instability?

Answer 2

• Multiple acute episodes linked to trivial event (although can occur in chronic LBP) (such as picking up a paper clip)
• Patient complains of a painful catch, locking, back “gave out.”
• History of temporary or diminishing response to CMT.
• See CSPE protocol Lumbar Functional Instability for more

Question 3

What is the positive physical exam findings for lumbar instability?

Answer 3

• Positive prone instability test
• Painful arc during AROM (especially when coming out of flexion) or first 3rd of a sit up (Farfan’s sit up test)
• Patient complains of a painful catch during AROM.
• Patient’s quality of movement is abnormal (e.g., displays an instability catch and cannot move smoothly through the plane of motion).
• Segmental motion palpation reveals hypermobility (or at least may not show hypomobility).

Question 4

How do you perform the prone instability test?

Answer 4

• Patient with stomach on table and knees on ground
• Pressure on spinous process that hurts,
• Release pressure and they lift their legs up
• Reapply pressure to the segment
  Positive = pain decrease

Question 5

What is the clinical prediction rule for lumbar instability?

Answer 5

<40
+prone instability test
aberrant motions with AROM,
SLR bilateral average 91°