Putting Low Back Pain in a Box--And Keeping It There
Medical professionals continue to search for ways to put chronic low back pain in a box and nail the lid shut. Expert physical therapists have recently unveiled a new way to classify back pain. Their new system guides clinicians in finding and treating causes of pain. The new system may be just the "box" that medical science wants.

Actually, there are five such boxes, or categories, in the new system. The categories describe spinal movements and positions that people tend to use during routine activities. The system is based on the idea that people with back pain may have developed unhealthy habits in how they move or position their spine. These incorrect positions or movements happen over and over again during daily activities. The authors call these faulty movement patterns lumbar movement dysfunctions. Over time, these dysfunctional movements can cause soreness. They may eventually lead to a full-blown back problem.

The classification system is useful for identifying which lumbar movement dysfunction is to blame. First the problem is classified in one of the five categories. Patients are then shown how to avoid the positions and movements that may be causing the pain, thus keeping their pain "in the box." Strategies are suggested for positioning the spine safely during exercise and activity. Even routine activities like bending and reaching may need to be modified to help the spine stay balanced.

The authors present a case study of a 55-year-old woman who had been dealing with back pain on and off for 40 years. When she came for help, she had been in pain for 10 weeks and hadn't gotten any relief with standard treatments. She felt pain whenever she bent back or twisted her trunk to the left. The lumbar movement dysfunction was categorized as "rotation with extension." Her physical therapist showed her ways to avoid moving or positioning her spine in rotation or extension during exercise and routine activities. After this one treatment, she came back and reported having 75% less pain in her back. Over the next three months and a total of eight physical therapy visits, her functional scores went from "severe disability" to "minimal disability." And the activities that used to cause her pain no longer gave her problems.

Had she kept on doing the same harmful movements, it is likely she would still be having problems. The authors acknowledge that other factors might have played into the patient's improvement. They encourage future research to validate this approach for helping people nail the lid on low back pain.

Katrina S. Maluf, MSPT, et al. Use of a Classification System to Guide Nonsurgical Management of a Patient With Chronic Low Back Pain. In Physical Therapy. November 2000. Vol. 80. No. 11. Pp. 1097-1110.