title: Articular dysfunction patterns in patients with mechanical low back pain: A clinical algorithm to guide specific mobilization and manipulation techniques.
abstract: Recent systematic reviews have demonstrated reasonable evidence that lumbar mobilization and manipulation techniques are beneficial. However, knowledge on optimal techniques and doses, and its clinical reasoning is currently lacking. To address this, a clinical algorithm is presented so as to guide therapists in their clinical reasoning to identify patients who are likely to respond to lumbar mobilization and/or manipulation and to direct appropriate technique selection. Key features in subjective and clinical examination suggestive of mechanical nociceptive pain probably arising from articular structures, can categorize patients into distinct articular dysfunction patterns. Based on these patterns, specific mobilization and manipulation techniques are suggested. This clinical algorithm is merely based on empirical clinical expertise and complemented through knowledge exchange between international colleagues. The added value of the proposed articular dysfunction patterns should be considered within a broader perspective.
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Dewitte
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium. Electronic address: barbara.cagnie@ugent.be.
authors.forename: B
authors.initials: B
authors.lastname: Cagnie
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Barbe
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Beernaert
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Vanthillo
authors.affiliation: Ghent University, Department of Rehabilitation Sciences and Physiotherapy, De Pintelaan 185 3B3, 9000 Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Danneels
mesh_terms: D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D059408:Pain Management; D010347:Patient Care Planning / Q000592:standards*; D010808:Physical Examination / Q000379:methods; D059825:Physical Therapists / Q000592:standards; D017410:Practice Guidelines as Topic; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome
keywords: Articular dysfunction patterns; Clinical reasoning; Lumbar spine; Mechanical low back pain; Spinal manipulation