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

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 movem...

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Veröffentlicht in:Physical therapy 2017-12, Vol.97 (12), p.1147-1157
Hauptverfasser: Alrwaily, Muhammad, Timko, Michael, Schneider, Michael, Kawchuk, Greg, Bise, Christopher, Hariharan, Karthik, Stevans, Joel, Delitto, Anthony
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container_end_page 1157
container_issue 12
container_start_page 1147
container_title Physical therapy
container_volume 97
creator Alrwaily, Muhammad
Timko, Michael
Schneider, Michael
Kawchuk, Greg
Bise, Christopher
Hariharan, Karthik
Stevans, Joel
Delitto, Anthony
description 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.
doi_str_mv 10.1093/ptj/pzx087
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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. 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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection
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
title Treatment-based Classification System for Patients With Low Back Pain: The Movement Control Approach
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