Posterior-to-anterior segmental testing in cLBP

Several studies have been published assessing the accuracy and association of pain with PA segmental motion testing (manual and algometry). An in vivo assessment in MRI in 2007 concluded lumbar-segmental hypermobility was likely associated with LBP. A PT study by Blinkley et al assessed inter-tester reliability of P-A testing and concluded; “there is poor inter-tester agreement reliability of P-A testing. Caution should be exercised when using P-A testing to assess segmental motion”. In 2005 (Beneck et al J Ortho Sport PT) examined the association between painful segment with P-A testing vs. hyper/hypo mobility with MRI utilized to determine actual motion. L5 was the most painful segment in nearly half the subjects with L4/L5 the least mobile. Their conclusions: “Assumptions of segmental motion cannot be inferred from pain associated with P-A pressure testing”.

Dr. Kennedy comment: These studies can be instructive for our clinical examination of motion disorders as well as re-assessing the accuracy of our palpation. The Mcgill shear instability test affords us the ability to add muscle-contraction (force-closure) to assess the effects of contraction on segmental pain and motion. Where P-A testing alone may afford inaccurate information adding “force-closure” can add substantial reliability and possible validity.

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