TBC Category 2: Stabilization Subgroup
Spinal instability is considered one of the important causes of low back pain, but is poorly defined and not well understood. Core stabilization exercises have become extremely popular for those with LBP, but are not the solution for all categories of LBP. This subgroup has to be identified primarily through physical examination findings.
Typically, this patient reports a “catching” sensation in the lumbar spine with change of trunk position (e.g., sit to stand, sit to lying). The examiner may also find aberrant movements during flexion/extension. For example, the patient cannot return to an erect position from flexion without use of hands on thighs (thigh walking).
It is recognized that functional instability (see Table 4) can exist in the absence of radiological evidence of spinal instability (e.g., spondylolisthesis, movement on flexion-extension films).24,25 The validity of radiographic evidence of excessive motion between vertebrae has been questioned on the basis of studies showing wide inter-individual and intra-individual variations in spinal motion characteristics in asymptomatic subjects, therefore making it difficult to establish thresholds identifying a spine as being unstable.6,26