Movement Control Tests For Lumbar Spine

Original Editor - Carin Hunter based on the course by Nick Rainey
Top Contributors - Carin Hunter, Rishika Babburu and Jess Bell

Introduction

In the physiotherapy community there is a general thought that the lack of movement control is related to a poor adaptations due to a "lack of awareness" which could contribute to lower back pain. There is little evidence to support this but it is a good assessment tool, often being used as an asterisk sign. There is little difference in movement control patterns between those with lower back pain and without. Movement control tests should be considered without other larger impairments. What is not tested is how these compare to posterior chain strengthening or aerobic conditioning, both of which have been shown to improve low back pain. Further, biomedical impairments should always be graded against psychological and social “impairments”.

Some patients may benefit by knowing the impairments found and others may not. This is discretionary. It depends on how much the patient needs to know why they are in pain and the purpose of your interventions. Too much information can be unhelpful, but insufficient information can be frustrating. Good questioning will elicit patient concerns so you know what needs to be addressed.

Six Movement Control Tests

In the study by Luomajoki, as patients did not know the tests, only clear movement dysfunction was rated as incorrect. If the movement control improved by instruction and correction, it was considered that it did not infer a relevant movement dysfunction. Tests are considered positive if with cueing and demonstration the person can not perform correctly. The following six movement control test were selected by Nick Rainey for the mentoring course. They come from the following articles:

• Luomajoki H, Kool J, De Bruin ED, Airaksinen O. Reliability of movement control tests in the lumbar spine. BMC musculoskeletal disorders. 2007 Dec;8(1):1-1.
• Meier R, Emch C, Gross-Wolf C, Pfeiffer F, Meichtry A, Schmid A, Luomajoki H. Sensorimotor and body perception assessments of nonspecific chronic low back pain: a cross-sectional study. BMC Musculoskeletal Disorders. 2021 Dec;22(1):1-0.

1. Waiter’s Bow:

Test protocol: Flexion of the hips in upright standing without movement (flexion) of the low back.

Correct: Forward bending of the hips 50-70°  without flexion of the low back.

Incorrect: Flexion occurring in the low back prior to 50° of hip flexion.

Waiter’s Bow

2. Sitting Knee Extension:

Test protocol: Upright sitting with corrected lumbar lordosis; extension of the knee without movement (flexion) of low back

Correct: Upright sitting with lumbar lordosis; extension of the knee to within 50° of straight without movement of LB.

Incorrect: Low back moving in flexion prior to within 50° of straight.  

Sitting Knee Extension

3. Rocking Backwards:

Test protocol: Transfer of the pelvis backwards ("rocking") in a quadruped position keeping low back in neutral.

Correct: 120° of hip flexion without movement of the low back by transferring pelvis backwards.

Incorrect: Hip flexion causes flexion in the lumbar spine (typically the patient not aware of this).

Rocking Backwards

4. Prone Lying Knee Flexion:

Test protocol: Actively in prone

Correct: Active knee flexion at least 90° without extension movement of the low back and pelvis.

Incorrect: Low back does not stay neutral, but moves into extension

Prone Lying Knee Flexion

5. Posterior Pelvic Tilt:

Test protocol: Actively in upright standing.

Correct: Posterior pelvic tilt the pelvis while in standing by contracting the glute max while keeping the thoracic spine in neutral

Incorrect: Pelvis doesn't tilt or low back moves towards Ext./No gluteal activity/compensatory flexion in thoracic spine

Posterior Pelvic Tilt

6. Single-leg Stance:

Test protocol: Patient’s feet 12cm apart. Use a 20cm ruler and hold it on a stable object with the middle of the ruler lined up with the patient's umbilicus.

Correct: The patient’s umbilicus has <2cm difference side to side and <10 cm transfer on either foot.

Incorrect: Lateral transfer of belly button >2cm difference side to side or > 10 cm in either direction .

Single-leg Stance

Research Discussion

The research by Meier et al evaluated whether there was a difference between people in pain and people without pain. For each positive test on the movement control tests there was an odds ratio of 1.92 more likely to have chronic low back pain.In another study by Khodadad et al Both the cognitive functional treatment and lumbar stabilization treatment improved pain and the movement control tests.The cognitive functional treatment group class sessions involved education, exercise, and relaxation/mindfulness. Stabilization group received cues on how to properly control the spine during the following exercises which were held for 3 seconds:

1. Planks
2. Bridge
3. Bird-dog
4. Side bridge
5. Curl-up

In an article by Lehtola at al , motor control exercises improved disability more than specific exercise at 3 and 12 month follow-up. The motor control exercises were more “specific” instead of general. In the article, pictures are shown of each of the specific and general exercises used but the details of the specific exercises are unclear. The goal was to train movements in different positions and re-educate how to move and control the lumbar spine in relation to the hips and thoracic spine. The general exercises are common core exercises. Both of these groups are very similar to Koumantakis’ article in 2005. The major difference is that in this current research they screened for who psychosocial limiting factors and for those positive on at least 2 of the movement control tests which explains the difference in their results.