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Predicting Pain and Function in Patients with Low Back Pain
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Posted on: 04/22/2005
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Patients with low back pain are often examined by physical therapists. Finding the right tests to guide the therapist's decisions about treatment is the focus of this study. The goal is to find out which tests will accurately measure the patient's symptoms and function. Finding the link between physical examination tests and the severity of low back pain (LBP) and level of function can help therapists plan better patient care.
Older adults (men and women 55 years old and older) with degenerative spinal conditions were included in this study. All had LBP for six months or more. At least half the patients had spinal stenosis. Stenosis is a narrowing of the spinal canal. Everyone's back pain was made worse by extending the low back area.
Tests included muscle strength, sensation, movement, and pressure through the spine. One special test called the quadrant test extends and rotates the lower spine while putting pressure through the spinal column. This position narrows the space for the spinal nerves and causes pain with pressure on the nerve.
The tests that best matched the patient's symptoms were (in order from best to least predictor):
quadrant test
leg muscle weakness
abnormal reflexes
The researchers found that patients with back AND hip pain had less function than those with just back pain. Patients with better education also had less severe symptoms and better function. Patients with a positive quadrant test had the worst pain. However the quadrant test was not able to predict the patient's level of function. Leg pain was a better predictor of poor function.
The authors conclude the quadrant test is a good one to use with older adults who have degenerative spine conditions. This test predicts pain but not function. This is especially true when the patient has back and hip pain or leg weakness. More research needs to be done to find a test to predict function.
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References:
Mark A. Lyle, PT, MSPT, et al. Relationship of Physical Examinatin Findings and Self-Reported Symptom Severity and Physical Function in Patients with Degenerative Lumbar Conditions. In Physical Therapy. February 2005. Vol. 85. No. 2. Pp. 120-133.
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