Lumbar instability is clinically characterized by a painful arc in a certain direction

Lumbar instability is clinically characterized by a painful arc in a certain direction, rather than end range pain or limitations in range of motion (ROM); often segmental shifts are visible in the painful direction, neural tissue provocation is generally normal. Movement dysfunctions can be divided into several directional patterns: patterns towards flexion or extension, lateral shift patterns and multidirectional patterns. The physical examination of patients presenting chronic low back pain (CLBP) due to instability should be targeted at identifying the symptomatic segment and possible directional specificity of the problem. Furthermore, the neuromuscular strategy of dynamic stabilization should be determined and a relationship must be found between the symptoms and local muscle control. When specific motor deficits are present, a motor learning model encompassing specific training of local muscles is appropriate: if an incorrect movement pattern is identified, components of this movement should be isolated and retrained in functional tasks > from O'Sullivan; Manual Therapy (2000) 2-12. All rights reserved to Harcourt Publishers Ltd.