Movement System Impairments of the Lumbar Spine
Shirley Sahrmann, PT, PhD, FAPTA
Professor Emerita Physical Therapy, Neurology, Cell Biology & Physiology
Washington University School of Medicine St. Louis
Consistent with practitioners who are 1) responsible for a system of the body, 2 0 recognize that movement can induce pathoanatomical conditions, and 3) educated at the doctoral level, is the use of diagnostic categories. Just as physicians have described pathological conditions of body systems so should therapists describe kinesiopathologic and pathokinesiologic conditions. Neither other health care practitioners or the public will recognize the expertise of the physiotherapists nor the existence of movement impairment syndromes until labels are used that refer to well described syndromes.
Movement System Impairment Syndromes of the lumbar spine are named for the alignment and/or movement direction that most consistently causes symptoms and that is impaired. Correction of the movement impairment with the result that the symptoms are decreased or eliminated further supports the diagnosis.
A systematic exam involving movement of the trunk and limbs in a variety of positions is used to assess the movement impairments. Evidence for the syndromes/classification has been found for the reliability of the tests, the validity of the categories, and that movements of the limbs that cause movement of the spine and symptoms can be corrected eliminating or reducing the symptoms.
The effectiveness of preventing spinal motion during basic activities has also been demonstrated. Early and greater motion of the spine during limb and trunk motions has been found to distinguish the patient with low back pain from the individual without low back pain. The classifications have been studied in patients with chronic low back and for which there is evidence are extension, extension-rotation, and rotation. The syndromes are described and an examination will be demonstrated.