The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report.
OBJECTIVE
To examine the effect on symptoms of modifying patient-preferred movements and alignments of the lumbar spine during patient examination.


METHODS
Repeated-measures study in which patients with low back pain (LBP) participated in a standardized examination that included tests of symptoms with various movements and positions.


METHODS
Six university-affiliated outpatient physical therapy clinics and the local community.


METHODS
Five trained physical therapists examined a total of 185 patients (102 women, 83 men; mean age, 41.89+/-13.29 y) with LBP. The majority of patients had multiepisode, chronic LBP.


METHODS
Not applicable.


METHODS
The examination included tests of symptoms with various alignments and movements in several different positions. Seven tests were designated as primary tests. Tests that increased symptoms were followed immediately by a secondary test in which (1) patient-preferred lumbar spine movement was modified or (2) the lumbar spine was positioned in a neutral alignment. Patients reported the effect of the secondary test on symptoms relative to their symptoms with the primary test. Three responses were possible: symptoms increased, remained the same, or decreased.


RESULTS
Eighty-three percent of the patients reported an increase in symptoms with 1 or more of the 7 primary tests. Ninety-five percent who reported an increase in symptoms with at least 1 of the primary tests reported a decrease in symptoms with 1 or more of the 7 secondary tests. The majority of patients reported a decrease in symptoms when the spinal movement or alignment was modified for 6 of the 7 secondary tests.


CONCLUSIONS
Modifying the symptom-provoking movements and alignments of the spine during symptom testing resulted in a decrease in symptoms for the majority of patients. Information about specific modifications that provide relief of LBP symptoms is important because it can be used to design a treatment program that focuses on training a patient to modify the same movements and alignments in their everyday activities.
Van Dillen
Linda R
LR
Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108-2212, USA. vandillen1@msnotes.wustl.edu
Sahrmann
Shirley A
SA
Norton
Barbara J
BJ
Caldwell
Cheryl A
CA
McDonnell
Mary Kate
MK
Bloom
Nancy
N
D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation*; D008161:Lumbosacral Region; D008297:Male; D008349:Manipulation, Orthopedic / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D008923:Missouri; D010358:Patient Participation / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D013131:Spine / Q000503:physiopathology