Aktive Bewegungstests zur Evaluation der klinischen LWS-Instabilität[1]

Zusammenfassung

Für eine gezielte Untersuchung und Behandlung von Patienten mit unspezifischen lumbalen Rückenschmerzen scheint es unabdingbar, klinische Subgruppen dieser Population zu differenzieren. Der vorliegende systematische Review erörtert die Frage, ob und in welcher Form aktive Bewegungstests im Rahmen der Funktionsuntersuchung zur Evaluation einer klinischen LWS-Instabilität beitragen. Durch die Inspektion und Beurteilung von Positionen und aktiven Bewegungen des Rumpfes und der Extremitäten lassen sich verschiedene klinische Muster der LWS-Instabilität unterscheiden. Untersuchungen der Reliabilität und Validität dieser aktiven Bewegungstests zeigen ermutigende Resultate auf.

Abstract

For the specific examination and treatment of patients with unspecific low back pain it seems necessary to differentiate clinical subgroups of this population. This systematic review investigates the question whether or not and in which manner active movement tests contribute to the evaluation of clinical lumbar spine instability. It is possible to differentiate various clinical patterns related to lumbar spine instability by inspecting and evaluating postures and active movements of the trunk, the upper and the lower limb. Studies investigating the reliability and validity of these active movement tests present encouraging results.

Schlüsselwörter

unspezifische lumbale Rückenschmerzen - klinische Instabilität - Funktionsuntersuchung - Reliabilität - Validität

Key words

non-specific low back pain - clinical instability - physical examination - reliability - validity

1 Die Arbeit wurde im Rahmen des svomp-Nachdiplomstudiums 2004 - 2006 erstellt.

Literatur

• 1 Airaksinen O, Brox J I, Cedraschi C. et al .European Guidelines for the Managment of Chronic Non-Specific Low Back Pain. European Commission, Research Directorate General. www.backpaineurope.org2005
• 2 Bogduk N. The anatomical basis for spinal pain syndromes.  Journal of Manipulative and Physiological Therapeutics. 1995;  18 603-605
• 3 Bogduk N. Clinical anatomy of the lumbar spine and sacrum. Edinburgh; Churchill Livingstone 1997 3 rd ed
• 4 Bossuyt P M, Reitsma J B, Brunds D E. et al . Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.  BMJ. 2003;  326 41-44
• 5 Bouter L M, Tulder M W, Koes B W. Methodologic issues in low back pain research in primary care.  Spine. 1998;  23 2014-2020
• 6 Cook van C, Brismée J M, Sizer P S. Subjective and ojective descriptors of clinical spine instability.  Manual Therapy. 2006;  11 11-21
• 7 Coste J, Paolaggi J, Spira A. Classification of non-specific low back pain II. Clinical diversity of organic forms.  Spine. 1992;  17 1038-1042
• 8 Dankaerts W, O’Sullivan P B, Straker L M. et al . The inter-examiner reliability of a classification method for non-specific chronic low back pain patients with motor control impairment.  Manual Therapy. 2006;  11 28-39
• 9 Delitto A, Erhard R E, Bowling R W. A treatment based classification approach to low back pain syndrome: identifying and staging patients for conservative treatment.  Physical Therapy. 1995;  75 470-489
• 10 Van Dillen L R, Sahrmann S A, Norton B J. et al . Reliability of physical examination items used for classification of patients with low back pain.  Physical Therapy. 1998;  78 979-988
• 11 Van Dillen L R, Sahrmann S A, Norton B J. et al . Movement system impairment-based categories for low back pain: stage 1 validation.  Journal of Orthopaedic and Sports Physical Therapy. 2003;  33 126-142
• 12 Van Dillen L R, Sahrmann S A, Norton B J. et al . The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report.  Archives of Physical Medicine and Rehabilitation. 2003;  84 313-322
• 13 Van Dillen L R, Sahrmann S A, Wagner J M. Classification, intervention, and outcomes for a person with lumbar rotation with flexion syndrome.  Physical Therapy. 2005;  85 336-351
• 14 Dillingham T. Evaluation and management of low back pain: an overview.  State of the Art Reviews. 1995;  9 559-574
• 15 Dupuis P, Yong-Hing K, Cassidy D. et al . Radiological diagnosis of degenerative spinal instability.  Spine. 1985;  10 262-276
• 16 Frymoyer J W, Pope M H. Segmental instability.  Semin Spine Surgery. 1991;  3 109-118
• 17 Hicks G E, Fritz J M, Delitto A. et al . Interrater reliability of clinical examination measures for identification of lumbar segmental instability.  Archives of Physical Medicine and Rehabilitation. 2003;  84 1858-1864
• 18 Kirkaldy-Willis W. Managing low back pain. New York; Churchill Livingstone 1993
• 19 Lee D. The pelvic girdle. Edinburgh; Churchill Livingstone 1999 2nd ed
• 20 Maluf K S, Sahrmann S A, Dillen L R. Use of a classification system to guide nonsurgical management of a patient with chronic low back pain.  Physical Therapy. 2000;  80 1097-1111
• 21 Nachemson van A. Lumbar spine instability.  Spine. 1985;  10 290-291
• 22 Nachemson A. Newest knowledge of low back pain. A critical look.  Clin Orthop Relat Res. 1992;  279 8-20
• 23 O’Sullivan P B. Lumbar segmental „instability”: clinical presentation and specific stabilizing exercise management.  Manual Therapy. 2000;  5 2-12
• 24 O’Sullivan P B, Burnett A, Floyd A N. et al . Lumbar repositioning deficit in a specific low back pain population.  Spine. 2003;  28 1074-1079
• 25 O’Sullivan P B. Grieve’s modern manual therapy. Edinburgh; Churchill Livingstone 2004 3 rd ed
• 26 Panjabi M M. The stabilizing system of the spine. Part I: Function, dysfunction, adaptation and enhancement.  Journal of Spinal Disorders. 1992;  4 383-389
• 27 Panjabi M M. The stabilizing system of the spine. Part II: Neutrale zone and instability hypothesis.  Journal of Spinal Disorders. 1992;  4 390-397
• 28 Paris S. Physcal signs of instability.  Spine. 1985;  10 277-279
• 29 Pope M H, Panjabi M M. Biomechanical definitions of spinal instability.  Spine. 1985;  10 255-256
• 30 Richardson C A, Hodges P W, Hides J A. Therapeutic exercise for lumbopelvic stabilization. Edinburgh; Churchill Livingstone 1999 2nd ed
• 31 Sahrmann S A. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis; Mosby 2002
• 32 Schöttker-Königer T. Angewandte Physiologie. 3: Therapie, Training, Tests. Stuttgart; Thieme 2001
• 33 STARD checklist. www.consort-statement.org/mod_product/uploads/STARD% 202 003 % 20checklist.pdf
• 34 Van Tulder M W, Assendelft W J, Koes B W. et al . Method guidelines for systematic reviews in the cochrane collaboration back review group for spinal disorders.  Spine. 1997;  22 2323-2330
• 35 Waddell G. Modern management of spinal disorders.  Journal of Manipulative and Physiological Therapeutics. 1995;  18 590-596

1 Die Arbeit wurde im Rahmen des svomp-Nachdiplomstudiums 2004 - 2006 erstellt.