back pain instability

 Spinal Instability


Spinal Instability may lead to back pain. The word ‘instability’ is not well – defined though. In the clinic, physiotherapists often check the spine in order to establish if there is any excessive movement in spinal segments. We talk about spinal instability mostly in relation to the lower back and lower back pain.


Spinal instability and disability


Patients with lumbar instability may develop a substantial disability. The loss of a normal pattern of spinal motion is at the root of the pain and/or neurologic dysfunction. According to The American Academy of Orthopedic Surgeons ‘Segmental instability is an abnormal response to applied loads, characterized by motion in motion segments beyond normal constraints.’


What is causing spinal instability?


There are several potential causes:

• degenerative disease
• facet joint hypertrophy
• postoperative status
• postoperative spinal fusion
• trauma to the spine or its surrounding structures
• development disorders, like scoliosis and other congenital spine lesions
• infection
• tumors


Symptoms of spinal instability


Patients with lumbar instability tend to suffer from recurrent, chronic recurrent low back pain, a constant nagging pain that gradually increases. This pain can also be a residue of acute complaints. There are many other signs that may indicate spinal instability:

  1. The feeling of the spine giving way
  2. A visually observable or palpable hitch in the lumbar spine, mostly during a change of position.
  3. Segmental shifts or hinging associated with the painful movement.
  4. Increased mobility at the concerned movement segment, mostly while bending forward or backward
  5. Excessive intervertebral motion at the symptomatic level or an increased intersegmental motion at the level above the concerned movement segment.
  6. Local pain.
  7. Low back pain during long static load and deflexion.
  8. Pain during a change of position and while bending or lifting.
  9. A painful arc.
  10. Gowers sign: the inability to return to erect standing from forward bending without the use of the hands to assist this motion.
  11. Frequently crack or pop the back to reduce the symptoms, self-manipulation.


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