A critical review of lumbar segmental instability: theory, diagnosis and treatment.
Item
- Title
- A critical review of lumbar segmental instability: theory, diagnosis and treatment.
- Author(s)
- Burns, C
- Abstract
- One of the aims of osteopathic treatment is increasing movement in hypomobile areas. More recently however, there is a growing consensus among manual therapists that too much movement in the lumbar spine can cause low back pain (LBP) (Harreby et al. 1999). Thus, a condition of lumbar hypermobility, called "lumbar segmental instability" (LSI) has been proposed. The proposed treatment for LSI is stability exercises (SE), which are essentially the same as the more well known core stability exercises. Underlying both CS and LSI is the theory that that certain exercises can help relieve low back pain (LBP), however LSI has a more extensive theory on the origins of this pain. This critical review examined whether LSI is a valid diagnosis, and if SE are an effective treatment. It also looked at potential dangers from performing SE. The aim of the review was to see if there is evidence for a ubgroup of LBP patients that would benefit from SE. Discussion A detailed look at the literature surrounding LSI and SE shows that there is little evidence in support of either. LSI proponents claim that several neuromuscular deficits are involved in the condition. There are actually no studies on people with LSI with which to support these assertions. Thus, there is no actual proof of the theory behind LSI. Proponents of LSI take their evidence base from LBP studies. This review concludes that the LBP studies do not provide sufficient evidence for the deficits proposed in LSI. A small number of studies have been done on the diagnosis of LSI. Results indicate that diagnostic criteria could be agreed on with further research. There is evidence that some of the proposed deficits in LSI can be resolved by performing SE. However, it is unclear whether reversing these deficits is responsible for the reduction in pain, rather than psychological factors. Furthermore, there is insufficient research to assess whether SE are more effective than general exercise as a cure for LSI or hypermobility/instability conditions. Similarly, there is not enough research to determine whether the compression generated whilst performing SE could be harmful. Conclusion LSI and SE do not appear to have a sufficient evidence base to support their use. Further research is required to determine whether LSI is a valid condition, and SE an effective treatment.
- presented at
- European School of Osteopathy
- Date Accepted
- 2011
- Date Submitted
- 22.1.2013 16:23:35
- Type
- osteo_thesis
- Language
- English
- Submitted by:
- 62
- Pub-Identifier
- 15257
- Inst-Identifier
- 1229
- Keywords
- Lumbar stability
- Recommended
- 0
- Item sets
- Thesis
Burns, C, “A critical review of lumbar segmental instability: theory, diagnosis and treatment.”, Osteopathic Research Web, accessed April 28, 2024, https://www.osteopathic-research.com/s/orw/item/808