The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: A preliminary report

Objective: To examine the effect on symptoms of modifying patient-preferred movements and alignments of the lumbar spine during patient examination. Design: Repeated-measures study in which patients with low back pain (LBP) participated in a standardized examination that included tests of symptoms with various movements and positions. Setting: Six university-affiliated outpatient physical therapy clinics and the local community. Participants: Five trained physical therapists examined a total of 185 patients (102 women, 83 men; mean age, 41.89+/-13.29y) with LBP. The majority of patients had multiepisode, chronic LBP. Interventions: Not applicable. Main Outcome Measures: The examination included tests of symptoms with various alignments and movements in several different positions. Seven tests were designated as primary tests. Tests that increased symptoms were followed immediately by a secondary test in which (1) patient-preferred lumbar spine movement was modified or (2) the lumbar spine was positioned in a neutral alignment. Patients reported the effect of the secondary test on symptoms relative to their symptoms with the primary test. Three responses were possible: symptoms increased, remained the same, or decreased. Results: Eighty-three percent of the patients reported an increase in symptoms with 1 or more of the 7 primary tests. Ninety-five percent who reported an increase in symptoms with at least 1 of the primary tests reported a decrease in symptoms with 1 or more of the 7 secondary tests. The majority of patients reported a decrease in symptoms when the spinal movement or alignment was modified for 6 of the 7 secondary tests. Conclusions: Modifying the symptom-provoking movements and alignments of the spine during symptom testing resulted in a decrease in symptoms for the majority of patients. Information about specific modifications that provide relief of LBP symptoms is important because it can be used to design a treatment program that focuses on training a patient to modify the same movements and alignments in their everyday activities.