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DOI: 10.1055/s-0028-1109940
© Georg Thieme Verlag KG Stuttgart · New York
Klinisches Muster der klinisch lumbalen Instabilität[1]
Systematischer ReviewClinical Pattern of Clinical Lumbar InstabilitySystematic ReviewPublication History
Manuskript eingetroffen: 26.2.2009
Manuskript akzeptiert: 25.5.2009
Publication Date:
05 January 2010 (online)

Zusammenfassung
Die klinisch lumbale Instabilität stellt eine Subgruppe der unspezifischen lumbalen Rückenschmerzen dar. Auf der Basis der aktuellen Literatur wird dieses klinische Muster nach dem Schema einer physiotherapeutischen Untersuchung beschrieben, die subjektive und objektive Zeichen sowie Tests beinhaltet. In der Praxis ist das gängigste Mittel zur Ermittlung der Aktivität der tiefen lumbalen Stabilisatoren das Biofeedback-Gerät (PBU). Die passiven Untersuchungstechniken (PAIVM und PPIVM) spielen bei der Differenzierung zur strukturellen Instabilität eine wichtige Rolle.
Wegen der dürftigen Reliabilität der segmentalen Beweglichkeitsmessung sollten die Ergebnisse der passiven Tests immer im Kontext mit den aktiven Tests und den subjektiven Merkmalen gesehen werden. Die in der alltäglichen Praxis einfach anzuwendenden aktiven Tests weisen eine gute Reliabilität auf.
Abstract
Clinical lumbar instability represents a subgroup of unspecific lumbar back pain. On the basis of current literature this clinical pattern is described according to a physiotherapeutic examination scheme including subjective and objective signs as well as tests. A well-established practical tool in order to measure the activity of deep lumbar stabilisers is the biofeedback instrument (PBU). Passive examination techniques (PAIVM and PPIVM) play a vital role for the differentiation from structural instability.
Due to the poor reliability of segmental movement measurement passive tests results should always be seen in context with active tests and subjective characteristics. The in daily practice easily implementable active tests show good reliability.
Schlüsselwörter
funktionelle Instabilität - subjektive Merkmale - objektive Funktionsuntersuchung - Reliabilität - Validität
Key words
functional instability - subjective characteristics - objective function examination - reliability - validity
1 Die Arbeit wurde im Rahmen der SVOMP-OMT-Ausbildung 2006 – 2008 erstellt.
Literatur
- 1
Abbott J H, McCane B, Herbison P. et al .
Lumbar segmental instability: a criterion-related validity study of manual therapy
assessment.
BMC Musculoskeletal Disorders.
2005;
6
56
DOI: 10.1186 / 1471 – 2474 – 6-56
Reference Ris Wihthout Link
- 2
Abbott J H, Fritz J M, McCane B. et al .
Lumbar segmental mobility disorders: comparison of two methods of defining abnormal
displacement kinematics in a cohort of patients with non-specific mechanical low back
pain.
BMC Musculoskeletal Disorders.
2006;
7
45
DOI: 10.1186 / 1471 – 2474-7-45
Reference Ris Wihthout Link
- 3 Airaksinen O, Hildebrandt J, Manninon A F. et al .European Guidelines for the management of chronic non-specific low back pain. 2004 www.backpaineurope.org/web/files/WG2_Guidelines.pdf
Reference Ris Wihthout Link
- 4
Bergmark A.
Stability of the lumbar spine.
Acta Orthopaedica Scandinavica.
1989;
230
18-53
Reference Ris Wihthout Link
- 5
Billis E V, Foster N E, Wright C C.
Reproducibility and repeatability: errors of three groups of physiotherapists in location
spinal levels by palpation.
Manual Therapy.
2003;
8
223-232
Reference Ris Wihthout Link
- 6
Comerford M J, Mottram S L.
Functional stability re-training: principles and strategies for managing mechanical
dysfunction. Masterclass.
Manual Therapy.
2001;
6
3-14
Reference Ris Wihthout Link
- 7
Comerford M J, Mottram S L.
Movement and stability dysfunction – contemporary developments.
Manual Therapy.
2001;
6
15-26
Reference Ris Wihthout Link
- 8
Cook C, Brismée J M, Sizer P S.
Subjective and objective descriptors of clinical lumbar spine instability: A delphi
study.
Manual Therapy.
2006;
11
11-21
Reference Ris Wihthout Link
- 9
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.
2005;
10
28-39
Reference Ris Wihthout Link
- 10
Descarreaux M, Blouin J S, Teasdale N.
Repositioning accuracy and movement parameters in low back pain subjects and healthy
control subjects.
Eur Spine J.
2005;
14
185-191
Reference Ris Wihthout Link
- 11
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
Reference Ris Wihthout Link
- 12
Van Dillen L R, Sahrmann S A, Norton B J. et al .
The effect of modifying patient-referred 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
Reference Ris Wihthout Link
- 13
Dupuis P R, Yong-Hing K, Cassidy J D. et al .
Radiologic diagnosis of degenerative lumbar spinal instability.
Spine.
1985;
10
262-276
Reference Ris Wihthout Link
- 14
French S D, GreenS, Forbes A.
Reliability of chiropractic methods commonly used to detect manipulable lesions in
patients with chronic low back pain.
Journal of Manipulative and Physiological Therapeutics.
2000;
23
231-238
Reference Ris Wihthout Link
- 15
Fritz M J, Erhard R E, Hagen B F.
Segmental instability of the lumbar spine.
Physical Therapy.
1998;
78
889-896
Reference Ris Wihthout Link
- 16
Fritz J M, Piva S R, Childs J D.
Accuracy of the clinical examination to predict radiographic instability of the lumbar
spine.
European Spine Journal.
2003;
14
743-750
Reference Ris Wihthout Link
- 17
Fritz J M, Whitman J M, Childs J D.
Lumbar spine segmental mobility assessment: An examination of validity for determining
intervention strategies in patients with low back pain.
Arch Phys Med Rehabil.
2005;
86
1745-1752
Reference Ris Wihthout Link
- 18
Hestboek L, Leboeuf-Yde C.
Are chiropractic tests fort he lumbo-pelvic spine reliable and valid? A systematic
critical literature review.
Journal of Manipulative and Physiological Therapeutics.
2000;
23
258-275
Reference Ris Wihthout Link
- 19
Hicks G E, Fritz J M, Delitto A.
Mishock J.
Interrater reliability of clinical examination measures for identification of lumbar
segmental instability, Archives of Physical Medicine and Rehabilitation.
2003;
84
1858-1864
Reference Ris Wihthout Link
- 20
Johansson F.
Interexaminer reliability of lumbar segmental mobility tests.
Manual Therapy.
2005;
10
331-336
Reference Ris Wihthout Link
- 21
Luomajoki H, Kool J, Bruin de E. et al .
Reliability of movement control tests in the lumbar spine.
BMC Musculoskeletal Disorders.
2007;
8
90
DOI: 10.1186 / 1471-2474-8-90
Reference Ris Wihthout Link
- 22 Luomajoki H, Kool J, Bruin de E. et al .Specificity of movement control tests of low back: a validation study. Low Back and Pelvic Pain Congress Barcelona; 2007
Reference Ris Wihthout Link
- 23 Maitland G D. Manipulation der Wirbelsäule. Heidelberg; Springer 2005 3. Aufl
Reference Ris Wihthout Link
- 24
Maluf K S, Sahrmann S A, Dillen L R.
Use of a classification system guide nonsurgical management of a patient with chronic
low back pain.
Physical Therapy.
2000;
80
1079-1111
Reference Ris Wihthout Link
- 25
Nachemson A L.
Advances in low-back pain.
Clinical Orthopaedics and Related Research.
1985;
200
266-278
Reference Ris Wihthout Link
- 26
Nachemson van A.
Lumbar spine instability.
Spine.
1995;
10
290-291
Reference Ris Wihthout Link
- 27
Németh J.
Aktive Bewegungstests zur Evaluation der klinischen LWS-Instabilität.
Manuelle Therapie.
2008;
12
14-24
Reference Ris Wihthout Link
- 28
O’Sullivan P B, Twomey L T, Allison G T.
Evaluation of specific stabilizing exercise in the treatment of low back pain with
radiologic diagnosis of spondylolysis or spondylosisthesis.
Spine.
1997;
22
2959-2967
Reference Ris Wihthout Link
- 29
O’Sullivan P B.
Lumbar segmental „instability”: clinical presentation and specific stabilizing exercise
management.
Manual Therapy.
2000;
5
2-12
Reference Ris Wihthout Link
- 30
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
Reference Ris Wihthout Link
- 31 O’Sullivan P B. „Clinical Instability” of the lumbar spine: it’s pathological basis, diagnosis, and
conservative management. Boyling J, Jull G Grieve’s modern manual therapy. The vertebral column Edinburgh; Elsevier 2004 3rd ed
Reference Ris Wihthout Link
- 32
O’Sullivan P B.
Diagnosis and classification of chronic low back pain disorders: Maladaptive movement
and motor control impairments as underlying mechanism.
Manual Therapy.
2005;
10
242-255
Reference Ris Wihthout Link
- 33
Ogon M, Bender B R, Hooper D M. et al .
A dynamic approach to spinal instability. Part II: Hesitation and giving-way during
interspinal motion.
Spine.
1997;
22
2859-2866
Reference Ris Wihthout Link
- 34
Panjabi M M.
The stabilizing system of the spine. Part 1: Function, dysfunction, adaption and enhancement.
Journal of Spinal Disorders.
1992;
4
383-389
Reference Ris Wihthout Link
- 35
Panjabi M M.
The stabilizing system of the spine. Part 2: Neutral zone and instability hypothesis.
Journal of Spinal Disorders.
1992;
4
390-397
Reference Ris Wihthout Link
- 36
Panjabi M M.
Clinical spinal instability and low back pain.
Journal of Electromyography and Kinesiology.
2003;
13
371-379
Reference Ris Wihthout Link
- 37
Paris S.
Physical signs of instability.
Spine.
1985;
10
277-279
Reference Ris Wihthout Link
- 38
Petersen T, Olsen S, Laslett M. et al .
Inter-tester reliability of a new diagnostic classification system for patients with
non-specific low back pain.
Australian Journal of Physiotherapy.
2004;
50
85-94
Reference Ris Wihthout Link
- 39 Richardson C A, Jull G A, Hodges P W. et al .Therapeutic exercise for spinal segmental stabilisation in low back pain. Edinburgh; Churchill Livingstone 1999 2nd ed
Reference Ris Wihthout Link
- 40 Sahrmann S A. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis; Mosby 2002
Reference Ris Wihthout Link
- 41 Schöttker-Königer T. Angewandte Physiologie. 3: Therapie, Training, Tests. Stuttgart; Thieme 2001
Reference Ris Wihthout Link
- 42
Seffinger M A, Najm W I, Mishra S I. et al .
Reliability of spinal palpation for diagnosis of back and neck pain.
Spine.
2004;
29
E413-E425
Reference Ris Wihthout Link
- 43
Stochkendahl M J, Christensen H W, Hartvigsen J. et al .
Manual examination of the spine: a systematic critical literature review of reproducibility.
Journal of Manipulative and Physiological Therapeutics.
2006;
29
475-486
Reference Ris Wihthout Link
- 44
Strender L E, Sjöblom A, Sundell K. et al .
Interexaminer reliability in physical examination of patients with low back pain.
Spine.
1997;
22
814-820
Reference Ris Wihthout Link
- 45 Taylor J, O’Sullivan P B. 2007.
Reference Ris Wihthout Link
- 46
Tom-Petersen. et al .
2004.
Reference Ris Wihthout Link
- 47
Trijffel E, Anderegg Q, Bossuyt P MM. et al .
Interexaminer reliability of passive assessment of intervertebral motion in the cervical
and lumbar spine: A systematic review.
Manual Therapy.
2005;
10
256-269
Reference Ris Wihthout Link
- 48 Van Tulder M, Becker A, Bekkering T. et al .European Guidelines for the management of acute nonspecific low back pain in primary
care. 1998 www.backpaineurope.org/web/files/WG1_Guidelines.pdf
Reference Ris Wihthout Link
- 49 Waddell G. Back pain revolution. Edinburgh; Churchill Livingstone 2004 2nd ed
Reference Ris Wihthout Link
- 50
White L J, Thomas J S.
The rater reliability of assessments of symptom provocation in patients with low back
pain.
Journal of Back and Musculoskeletal Rehabilitation.
2002;
16
83-90
Reference Ris Wihthout Link
1 Die Arbeit wurde im Rahmen der SVOMP-OMT-Ausbildung 2006 – 2008 erstellt.
Angelika Mannig
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Email: amannig@gmx.ch