Background and Purpose: There are several systems of classification and treatment of patients with low back pain (LBP) based on assessment of the effect of lumbar postures and movements on symptoms. ...The efficacy of one of these systems, The Movement System Impairment (MSI) method, has not yet been demonstrated in the literature. The purpose of this case report is to describe the approach of the MSI method for an individual with lumbar radiculopathy. Case Description: A 79-year-old woman with a history of chronic LBP was referred to PT with a physician's diagnosis of sciatica. The patient was classified utilizing a standardized MSI evaluation. She was instructed to modify her daily postures and movements, as well as perform specific exercises to address these impairments. Outcomes: Her Oswestry LBP disability score improved by over 30% and pain level per the NPRS improved by 3 out of 10 points. Discussion: Despite the challenges of advanced joint degeneration and neurological involvement, this approach of identifying and addressing specific movement impairments appeared helpful for this older individual.
Abstract Background People with low back pain (LBP) exhibit impaired anticipatory postural adjustments (APAs). Objective To evaluate whether current motor retraining treatments address LBP-associated ...changes in movement coordination during tasks that do and do not require APAs. Design Prospectively registered randomized controlled trial with a blinded assessor. Setting Outcome evaluations occurred in a university laboratory; treatments were carried out in outpatient physical therapy clinics. Patients Fifteen subjects without LBP and 33 subjects with chronic, recurrent, and nonspecific LBP. Intervention Twelve subjects with LBP received stabilization treatment, 21 received movement system impairment–based treatment, for more than 6 weekly 1-hour sessions plus home exercises. Measurements Pre- and post-treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded. Results Persons with LBP demonstrated an impaired APA compared with persons without LBP, characterized by increased premovement contralateral force application and increased postmovement trunk EMG amplitude, regardless of the task. After treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (ie, force application or EMG amplitude) in either task. Limitations Treating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out nonspecific effects of time or repeated exposure. Conclusions Movement impairments in persons with LBP are not limited to tasks requiring an APA. Stabilization and movement system impairment–based treatments for LBP do not ameliorate and may exacerbate APA impairments (ie, excessive force application and increased post-movement trunk muscle activation).
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