Lumbar instability occurs as a result of damage
to one or more of the structures that make up the three columns of
the spine. In some cases, this damage will lessen the ability of the
stabilising structures to resist mechanical stress and potentially
allow abnormal movement to occur at the intervertebral segment. With
repeated trauma, mild low back pain may be replaced by severe
episodes resulting in loss of function.
of the lumbar spine associated with fracture/dislocation is well
recognised and usually requires surgical intervention. Orthopaedic
surgeons, medical practitioners and physiotherapists have long
realised that a less severe form of instability exists which can
cause debilitating symptoms, while not displaying the dramatic
neurological implications that are associated with
Patients with lumbar spine clinical
instability have a history of recurring episodes of low back pain
with loss of mobility. These episodes may occur several times per
year. Patients have often been treated successfully with
manipulation initially but may find as the condition progresses that
any relief is only short-term.
In the acute phase, the pain
is debilitating with the patient usually describing a severe
catching pain in the lower lumbar spine. Generally all active
movements are tentative and restricted by pain. Palpation of the
affective segment will illicit pain if done quickly. If performed
slowly and carefully, increased accessory movement may be detected.
Role of physiotherapy
Physiotherapists play a
significant role in the treatment of instability of the lumbar
Physiotherapy treatment in the acute stage is aimed
primarily at pain relief. However, recent research has shown that
the long-term resolution of lumbar spine instability must involve
regular and intensive training of the paraspinal and abdominal
This training must be specific to particular muscle
groups (multifidis, transverse and oblique abdominals) if the
maximum stabilising effect is to be achieved without placing further
stress on the lower lumbar spine.
Also important in the
management of lumbar instability are mobilising exercises to help
restore the patient's movement. When the basic abdominal and
paraspinal contractions are mastered, the patient is then progressed
through a series of exercises designed to enable them to return to a
normal lifestyle with confidence.
Would you like the names of physiotherapists
who have a special interest in Lumbar Instability? Lumbar
Instability falls under the category of musculoskeltal.
Call us on (03) 9527 7532 or contact us here.
|By courtesy of the Australian Physiotherapy Association