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

The movement control tests aren’t magical, but should be considered without other larger impairments. They can be used as asterisk signs in some cases when there sufficient progress isn’t being made it may be a significant impairment. 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 nocebic, but insufficient information can be frustrating. Good questioning will elicit patient concerns so you know what needs to be addressed.

Tests are considered positive if with cueing and demonstration the person can not perform correctly.

ARTICLES

This research 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.

Both the cognitive functional treatment and lumbar stabilization treatment improved pain and the movement control tests.

The CFT 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: A) planks. (B) bridge. (C) bird-dog. (D) side bridge, and (E) curl-up.

Motor control exercises improved disability more than specific exercise at 3 and 12 month follow-up. This was evident on the RMDQ which is more sensitive for mild-moderate back pain than the ODI.

This is motor control exercises, not stabilization. It is “specific” instead of general. They give pictures of each of the specific and general exercises.The details of the specific exercises are not clear, but the goal was to train movements in different positions and how to move and control their lumbar spine in relation to their 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.

Six Movement Control Tests

1. Waiter’s Bow:

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.

2. Sitting Knee Extension:

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.  

3. Rocking Backwards:

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).

4. Prone Lying Knee Flexion:

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

5. Posterior Pelvic Tilt:

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

6. Single-leg Stance:

Setup: 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 .

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.