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Man Ther. 2009 Feb;14(1):52-60. Epub 2007 Nov 26.

Further examination of modifying patient-preferred movement and alignment strategies in patients with low back pain during symptomatic tests.

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Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA.


Our purpose was to examine the effect of modifying symptomatic movement and alignment tests in a sample of people with LBP referred to physical therapy. Fifty-one patients (19 males, 32 females; mean age 37+/-10.59 yr) with LBP and a mean Oswestry Disability Index score of 34+/-18% were examined. The examination included 28 primary tests in which patients used their preferred movement or alignment strategy and reported symptoms. Symptomatic tests were followed by a secondary test in which the patient's strategy was standardly modified to correct the spinal alignment or movement that occurred with the primary test. Symptoms and directions of movement or alignment modified were recorded. For 82% of the secondary tests, the majority of the patients' symptoms improved. For 54% of the secondary tests, some patients required modification of more than one direction of movement or alignment to eliminate symptoms. The findings suggest that the modifications described are generalizable across a number of tests with a moderately involved group of patients, and for individual tests there is variability in the numbers and directions of movements or alignments that appear to contribute to symptoms. Information obtained from the modifications is important because it can be used to confirm the patient's LBP classification and, within the context of the examination, immediately be used to teach the patient strategies to change movements and positions that appear to be contributing to his LBP.

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