Lumbar Instability

Low back pain may occur due to poor or prolonged postures, overuse, incorrect lifting techniques, reduced body awareness and/or overcompensation for weakness in other parts of the body.
Lumbar instability is a condition that can be associated low back pain, and ultimately long-term disability. Lumbar instability is a condition of the spine in which there is abnormal mobility or an abnormal joint between two or more vertebrae.

Stability in a healthy spine generally comes from an interaction between the spinal column and its ligaments, the nerves controlling movement, and the muscles which move the spine. When there is an injury to any of these components, there will be compensation from the uninjured components – leading to an imbalance which can lead to pain. Instability is a complex multi-system dysfunction, and hence it can be hard to differentiate which specific component is at fault.

To add complexity, there can be spine instability without the presence of radiographic anomaly. We call this functional instability – which is essentially an inability to control segmental movement. Nevertheless, radiographic or structural instability is the most common cause of spinal instability (actual damage to spinal structures).

Causes

These can be classified as:

1. Degenerative (such as wearing of intervertebral discs or cartilage)
   These degenerative problems are increased by poor posture, poor physical condition, muscular insufficiency, sedentary life, excess body weight, injury.
2. Congenital (such as from bone defects e.g., spondylolysis leading to spondylolisthesis; as well as in anomalies in spinal alignment e.g., scoliosis)
3. Acquired (such as after spinal surgery, or infections/tumours affecting the spine).

Some common characteristics of lumbar instability can include:

• Sensation of the spine giving way
• Excessive movement of a vertebra (alongside pain) when moving the spine.
• Pain with sustained postures
• Pain during change of position and while bending or lifting.
• Reduced postural control
• Poor activation of stabilising muscles
• Inability to return to erect standing after bending forward.

Physiotherapy management for lumbar instability

Physiotherapy plays a vital role in the treatment of lumbar instability. At My Physio My Health, your physiotherapist will conduct a thorough assessment of your lower back pain to determine the cause of your low back pain as well as the movements/postures at work or at home which may be contributing to the pain. This allows the physiotherapist to set a treatment plan specific to the client.

Your physiotherapist will guide you and teach you about which movements are best to avoid. Initially, we like to avoid bent over postures while holding a weight, or end-range postures, as these can overload stabilising structures. Additionally, you will be provided with a program to exercise the affected muscles and thus help stabilize the spine. Stabilisation exercises aim to retrain a precise co-contraction pattern of muscles of the spine, particularly deep in the low back and core. Stabilisation exercises have been shown successful in treating lumbar segmental instability and chronic low back pain.