The Active Straight Leg Raise Test and Lumbar Spine Stability

Liebenson, Craig; Karpowicz, Amy; Brown, Stephen H.M.; Howarth, Samuel J.; McGill, Stuart M.

doi:10.1016/j.pmrj.2009.03.007

Cited by 76 publications

(60 citation statements)

References 21 publications

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“…18,19 The sensitivity and specificity of the ASLR are good (0.87 and 0.94, respectively) for posterior pelvic pain in pregnancy. 20 Bridging maneuvers (Prone and Supine Bridge Tests) also seem to be reliable and valid methods to investigate stabilization endurance in patients with LBP.…”

Section: Description Of Tests and Diagnosis Proceduresmentioning

confidence: 95%

Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis

Ferrari¹,

Vanti²,

O’Reilly³

2012

Journal of Chiropractic Medicine

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Objective: Spondylolisthesis is a pathological condition characterized by the slipping of a vertebral body, compared with the underlying one, following structural and/or degenerative changes of the spine. The purpose of this case series is to describe clinical presentations and the conservative physiotherapy management of 4 patients with low back pain and lumbar isthmic spondylolisthesis. Clinical Features: Four patients aged 25, 43, 36, and 50 years presented with low back pain of various duration. Radiographs confirmed the presence of lumbar isthmic spondylolisthesis. Outcome measures included numerical rating scale, disability outcome measure (Oswestry Disability Index), spinal instability tests (Prone Instability Test, Passive Lumbar Extension test), and muscle function tests (Aberrant Movement Patterns, Active Straight Leg Raising, Prone and Supine Bridge Tests). Intervention and Outcomes: Treatment consisted of postural reeducation, stretching, and strengthening exercises. Over the course of individualized treatment, ranging from 8 to 10 treatment visits, outcomes improved for all 4 patients. Conclusion: This report describes varying clinical presentations and treatment of 4 patients with isthmic spondylolisthesis, suggesting that different pain generators could be managed by different conservative approaches.

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Section: Description Of Tests and Diagnosis Proceduresmentioning

confidence: 95%

Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis

Ferrari¹,

Vanti²,

O’Reilly³

2012

Journal of Chiropractic Medicine

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“…6,33,36 Paraspinal muscle activity, including LM activity, increases to control spinal motion and contributes to extension during the PSLR. 2,17,28,38 It is argued that an inability to control spinal motion or an increase in lumbopelvic pain during the ASLR, CLR, or PSLR reflects a deficit in trunk muscle function. Specifically in regard to the LM, there is an underlying assumption that its activity is reduced, and should be optimized, enhanced, or restored, in people with LBP.…”

Section: T T Conclusionmentioning

confidence: 99%

Behavior of the Lumbar Multifidus During Lower Extremity Movements in People with Recurrent Low Back Pain During Symptom Remission

MacDonald¹,

Dawson²,

Hodges³

2011

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Cross-sectional design. Objectives To investigate lumbar multifidus (LM) thickness differences, using ultrasound imaging in people during remission from recurrent low back pain (LBP) and healthy participants, during the following lower extremity movements: (1) active straight leg raise (ASLR), (2) crook-lying active leg raise (CLR), and (3) prone straight leg raise (PSLR). Background ASLR, CLR, and PSLR are used clinically to challenge the ability of the trunk muscles to control spinal motion in people with LBP, and it is believed that decreased LM activity is related to altered spinal control in this population. However, it is unclear whether LM behavior differs between healthy individuals and people with recurrent LBP during symptom remission in such tasks. Methods The present study used ultrasound imaging to measure LM percentage thickness change parasagitally at the L4-5 and L5-S1 levels in people with recurrent LBP during symptom remission and in healthy participants, during the ASLR, CLR, and PSLR tasks. Results LM percentage thickness change was greater in the recurrent LBP group than in healthy participants during the PSLR task (P<.01) and greater in both groups during the PSLR than the ASLR and CLR tasks (P<.01). LM percentage thickness change was greatest at L4-5 in both groups (P<.01) and during all tasks (P≤.02). No difference was found in LM percentage thickness change between groups in either the ASLR (P = .70)or CLR(P = .69)task. Conclusions These data suggest that, during symptom remission, individuals with recurrent LBP, compared to healthy individuals, may have greater activity in at least some parts of the LM. Further investigation is required to determine whether the LM percentage thickness change observed in this study may be explained by differential changes in deep and/or superficial fibers of LM activity. This observation may have implications for clinical practice, but requires further investigation. J Orthop Sports Phys Ther 2011;41(3):155–164, Epub 4 January 2011. doi:10.2519/jospt.2011.3410

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“…15,18,19 Recently, the ASLR test has also become a common assessment tool for lumbopelvic stability during sagittal plane movement in patients with ns-LBP. 13,[20][21][22] Altered movement control strategies have been identified during the ASLR test in patients with chronic groin pain 23 and LBP. 24 The AHAbd test was found to be the best clinical predictor for development of LBP during standing in previously asymptomatic individuals 11,16 with a diagnostic odds ratio (OR) of 3.85.…”

Section: Objectivesmentioning

confidence: 99%

Multiplanar lumbopelvic control in patients with low back pain: is multiplanar assessment better than single plane assessment in discriminating between patients and healthy controls?

Nelson-Wong

Gallant

Alexander

et al. 2016

Journal of Manual & Manipulative Therapy

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Objectives: Patients with low back pain (LBP) commonly have lumbopelvic control deficits. Lumbopelvic assessment during sagittal motion is incorporated into commonly used clinical examination algorithms for Treatment Based Classification. The purpose of this study was to investigate whether combined assessment of lumbopelvic control during sagittal and frontal plane motion discriminates between people with and without LBP better than single plane assessment alone. Methods: Nineteen patients with LBP and 18 healthy control participants volunteered for this study. The active straight leg raise (ASLR) and active hip abduction (AHAbd) tests were used to assess lumbopelvic control during sagittal and frontal plane motion, respectively. The tests were scored as positive or negative using published scoring criteria. Contingency tables were created for each test alone and for the combined tests (both positive/both negative) with presence/absence of LBP as the reference standard to calculate accuracy statistics of sensitivity (sn), specificity (sp), likelihood (zLR and 2LR), and diagnostic odds ratios (OR). Results: Active straight leg raise and AHAbd tests alone had sn of 0.63, 0.74, respectively, sp of 0.61, 0.50, respectively, and OR of 2.7, 2.8, respectively. The combined tests had sn50.89, sp50.60, and OR512.0. Forty percent of patients with LBP had control deficits in both planes of motion. Discussion: The AHAbd and ALSR tests appear to have greater diagnostic discrimination when used in combination than when used independently. A percentage of patients with LBP had control deficits in both planes, while others demonstrated uniplanar deficits only. These findings highlight the importance of multiplanar assessment in patients with LBP.Keywords: Low back pain, Lumbopelvic assessment, Active straight leg raise, Active hip abduction Level of Evidence: 2b (Diagnosis -exploratory cohort study with independent reference standard). ObjectivesLow back disorders are a significant health care issue in North America with an age-adjusted rate of 27.8% of all people over the age of 18 years reporting low back pain (LBP) each year, 1 and 80% of all individuals experiencing an episode of LBP during their lifetimes. 2 The economic and social impact of LBP is large, accounting for 1 in 25 health care resource visits resulting in an annual cost of $193.9 billion. 1 Despite the enormous resources that are dedicated to management of LBP, successful outcomes remain relatively low, having variable recurrence rates (5-60%) with an estimated 20% progressing into chronicity. 3The majority of individuals seeking treatment for LBP have no detectable structural cause with current imaging techniques and are therefore given the diagnosis of non-specific LBP (ns-LBP).4 Dysfunctional movement strategies, including kinematic and muscle activation differences, have been identified in people with ns-LBP when compared to healthy controls. [5][6][7][8] Asymptomatic people who reported a LBP response to a functional standing task also demonstrated diffe...

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The Active Straight Leg Raise Test and Lumbar Spine Stability

Cited by 76 publications

References 21 publications

Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis

Clinical presentation and physiotherapy treatment of 4 patients with low back pain and isthmic spondylolisthesis

Behavior of the Lumbar Multifidus During Lower Extremity Movements in People with Recurrent Low Back Pain During Symptom Remission

Multiplanar lumbopelvic control in patients with low back pain: is multiplanar assessment better than single plane assessment in discriminating between patients and healthy controls?

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