Lumbar Motor Control Impairment (MCI) | Signs & Symptoms

When we are talking about clinical lumbar instability, we are running into two problems. First of all, there is no clear definition of what lumbar instability actually is, and most often it is related to an enlarged neutral zone based on the concept of Panjabi. And second of all, there is no golden standard to measure this increased neutral zone. So we also don’t have any validated clinical tests to confirm or reject lumbar instability.

Therefore, the best tool we have is a Delphi study done by Cook et al. (2006) who asked experts in the field for the top clinical signs and symptoms of clinical lumbar instability.

The top five subjective factors, starting with the most mentionings are:

1. The feeling of giving away or giving out
2. Frequent self-manipulation or the frequent need to crack or pop one’s back.
3. Frequent bouts of episodes of symptoms
4. A history of painful catching or locking during twisting movements or bending movements of the spine.
5. Pain during transitional activities, for example, sitting to standing.

So now let’s look at the top five objective factors in clinical lumbar instabilit:

1. Poor lumbar pelvic control, including segmental hinging or pivoting with movement, as well as poor proprioceptive function.
2. Poor coordination or neuromuscular control, including juddering or shaking.
3. Decreased strength and endurance of local muscles at the level of segmental instability.
4. Aberrant movements, including changing lateral shift during lumbar active range of motion.
5. Pain with sustained positions and postures.

If you want to see the whole list of all signs and symptoms that were named, check out the article by Cook et al. (2006).

Always remember not to create a nocebo and to tell your patient that he has an unstable back or similar. You could rather tell him that you are trying to figure out if an exercise program could be an option for him.

Logically, you would think that a patient who exhibits a big part of these signs and symptoms will benefit from a stabilization program.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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If you are curious about other tests for motor control impairment in the lumbar spine, check out the following posts:

• Motor Control Dysfunction Screening
• Lumbar Local Stabilizers Assessment

There are several orthopedic tests for the diagnosis of radiographic lumbar instability:

• Prone Instability Test
• Passive Lumbar Extension Test
• Interspinous Gap Change
• Low Midline Sill Sign

References

Cook, C., Brismée, J. M., & Sizer Jr, P. S. (2006). Subjective and objective descriptors of clinical lumbar spine instability: a Delphi study. Manual therapy, 11(1), 11-21.