Lumbar: Reviews

Bardin L, King P, Maher C, Diagnostic triage for LBP: a practical approach to primary care, Med J Aust, 206,6:240-241, 2017

The narrative review updates the diagnostic triage process. It details the diagnostic specifics of Radicular Syndrome and of Serious Pathology. It also outlines some of the options for management approaches.

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Berthelot JM, Delecrin J, Maugars Y, Passuti N, Contribution of centralization phenomenon to the diagnosis, prognosis, and treatment of discogenic low back pain., Joint Bone Spine, 74:319-323, 2007

This review of centralisation concluded that it may indicate discogenic pain and is associated with better outcomes.

Donelson R, Improving spine care using Mechanical Diagnosis and Therapy., SpineLine, October 19-26, 2012

Summary of the system, with references, as relevant to the lumbar spine.

Donelson R, Evidence-based low back pain classification, Eur Med Phys, 40:37-44, 2004

Review of literature supporting Mechanical Diagnosis and Treatment includes the value of a non-specific classification system, the value of establishing directional preference, its reliability as an assessment system, and the prevalence of centralisation in the back pain population.

Ford JJ, Hahne AJ, Chan AYP, Surkitt LD., A classification and treatment protocol for low back disorders Part 3 - Functional restoration for intervertebral disc related disorders., Phys Ther Rev, 17:55-75, 2012

This review proposed criteria for a non-reducible discogenic pain sub-group, and proposed a management programme for this group, as part of a wider project from the same research group.

Ford JJ, Surkitt LD, Hahne AJ., A classification and treatment protocol for low back disorders Part 2 - Directional preference management for reducible discogenic pain., Phys Ther Rev,16:423-437, 2011

Presentation of directional preference management with other elements for reducible discogenic pain as the protocol to be followed in a trial protocol for patients classified with derangement and randomised to directional preference exercises or evidence-based practice.

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Huijbregts PA, Fact and Fiction of Disc Reduction: A Literature Review, J Man & Manip Ther,6:3, 137-143, 1997

This review examines the effect of manipulation, traction, and McKenzie exercises on the position of herniated nuclear material in lumbar inter-vertebral discs. From the evidence reviewed the author concludes that there is no proof that rotatory manipulation is effective and may lead to further displacement; that traction may temporarily influence displacement; and that extension exercises may influence displacement in non-degenerated discs, but does not allow conclusions about the effect in degenerated or herniated discs.

Kamper SJ, Maher CG, Hancock MJ, Koes BW, Croft PE, Hay E, Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence., Best Pract Res Clin Rheum, 24.181-191., 2010

Outline of key concepts related to sub-groups of back pain, and summary of current evidence. A 3-stage process is suggested as being necessary: 1) hypothesis generation to define sub-groups; 2) a randomised controlled trial to test that sub-group membership improves outcomes; 3) replication of stage 2. They concluded that all classification systems have not developed beyond first stage.

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Karayannis NV, Jull GA, Hodges PW., Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/ expert survey., BMC Muscul Dis, 13:24, 2012

A review of classification systems with confirmation from system experts. Five dominant movement based schemes were identified; including Mechanical Diagnosis and Therapy, Treatment-Based Classification, and Pathoanatomic classification systems. There was considerable diversity in how movement informs sub-grouping, but 2 dominant movement paradigms emerged: the 3 systems above all used loading strategies to elicit centralisation, the other 2 systems used modified movement strategies to document movement impairments.

Laslett, Mark., A Clinical Review: Evidence Based Diagnosis and Treatment of the Painful Sacroiliac Joint., JMMT, 16(3):142-154, 2008

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Macedo L, Bostick G, Maher, C, Exercise for Prevention of Recurrences of Non-Specific Low Back Pain, Phys Ther, 93(12):1587-1592, 2012

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Maher C, Underwood M, Buchbinder R, Non-specific low back pain, The Lancet, 389, 10070, 736-747, 2017

This ‘Seminar’ gives an overview of the current literature on non-specific low back pain. Review topics include epidemiology, risk factors, costs, clinical presentations, differential diagnosis, diagnostic investigations, prevention, clinical course, management and controversies. The review concludes that a research priority is the identification of LBP ‘phenotypes’, so that treatment can be targeted rather than generalised.

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May S, Donelson R, Evidence-informed management of chronic low back pain with the McKenzie method., Spine J, 8.134-141, 2007

Review that examines evidence for McKenzie method in an edition of Spine Journal that investigates the evidence for a wide range of different approaches in the treatment of chronic low back pain. Four guidelines, 5 systematic reviews, and 3 RCTs are quoted.

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Murphy DR, Hurwitz EL, A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain., BMC Musculoskel Dis, 8.75,2007

Clinical decision rule hypothesis that starts by excluding patients with red flags and addressing centralisation first before considering other management strategies.

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Wetzel FT, Donelson R, The role of repeated end-range / pain response assessment in the management of symptomatic lumbar discs., Spine J, 3:146-154, 2003

Review of current literature regarding usefulness of dynamic mechanical assessment for diagnosis andd management of reversible discogenic pathology: and identification of irreversible pathology that may benefit from sugery.