Treatment-based Classification System for Patients With Low Back Pain: The Movement Control Approach

• Published in: Physical therapy 2017-12, Vol.97 (12), p.1147-1157
• Main Authors: Alrwaily, Muhammad, Timko, Michael, Schneider, Michael, Kawchuk, Greg, Bise, Christopher, Hariharan, Karthik, Stevans, Joel, Delitto, Anthony
• Format: Article
• Language: English
• Subjects: Back pain; Care and treatment; Classification; Compensation; Diagnosis; Humans; Low back pain; Low Back Pain - diagnosis; Low Back Pain - rehabilitation; Lumbar Vertebrae - physiopathology; Medical treatment; Methods; Models, Theoretical; Movement; Pain; Pain management; Patients; Physical therapy; Physical Therapy Modalities - classification; Rehabilitation; Triage - methods; Viscoelasticity
• ISSN: 0031-9023; 1538-6724
• DOI: 10.1093/ptj/pzx087

Abstract We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumbar spine requires both local mobility and global stability. Local mobility means that the lumbar spine and its adjacent regions possess adequate nerve and joint(s) mobility and soft tissue compliance (ie, the malleability of tissue to undergo elastic deformation). Global stability means that the muscles of the lumbar spine and its adjacent regions can generate activation that is coordinated with various joint movements and incorporated into activities of daily living. Local mobility and global stability are housed within the bio-behavioral and socio-occupational factors that should be addressed during movement rehabilitation. This schema is converted into a practical physical examination to help the rehabilitation provider to construct a clinical rationale as to why the movement impairment(s) exist. The examination findings are used to guide treatment. We suggest a treatment prioritization that aims to consecutively address neural sensitivity, joint(s) and soft tissue mobility, motor control, and endurance. This prioritization enables rehabilitation providers to better plan the intervention according to each patient's needs. We emphasize that treatment for patients with low back pain is not a static process. Rather, the treatment is a fluid process that changes as the clinical status of the patient changes. This movement control approach is based on clinical experience and indirect evidence; further research is needed to support its clinical utility.