Clinical Prediction Rule: Stabilization Classification

A patient walks into your clinic complaining of low back pain. You aren’t sure exercises to give them, but you think that they would benefit from “core stabilization.” Instead of using a “cookie cutter” approach to treating patients, in which everyone receives the same treatment approach, you may be able to identify those patients who would respond better to stabilization exercises by using this study by Hicks et al. In the study, the researchers identified four factors that may identify patients who would benefit from lumbopelvic stabilization exercises:

  • Positive Prone Instability Test
  • Aberrant movements present
  • Average straight leg raise >91 degrees
  • Age <40

NOTE: Instead of performing the traditional prone instability test as described in the Hicks article, I use a modified version of the test. I begin by having the patient lay prone on the examination table. Apply a posterior to anterior pressure to the lumbar spine, and make note of any pain. At this point, have the patient raise their arms off the table while applying the pressure. If pain is present in the resting position but decreases when the arms are raised, the test would be positive.

So why is it important to provide these patients with stabilization exercises? Well Hides et al conducted a study on the effects of providing patients with stabilization exercises after an onset of low back pain. The study found that in the first year, those who performed specific stabilization exercises had a recurrence rate of 30% versus over 80% for those who did not perform core stabilization exercises.

Use these articles to help educate your patients on the importance of physical therapy in their recovery process, and that completing their rehabilitation may reduce their risk of setbacks in the future.

 

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