The Rotated Segment in Acute Low Back Pain

Abstract

A clinically relevant asymmetric rotation may be detected in acute low back pain patients who present with a lateral lumbar shift. It is suggested, that an examination category of asymmetric rotation could be used to guide treatment choices in the management of acute low back pain. Because of rotational coupling in the lumbar spine both rotation and sideflexion movements are considered relevant to the examination and treatment of asymmetric rotation. In this paper, five different tests are described that can be used for detecting the presence and direction of a clinically relevant asymmetric rotation. Further to this, it is recommended that a cluster of tests, rather than a single test is used in this clinical decision making process. Treatment for asymmetric rotation may include the use of rotation, sideflexion and sidegliding techniques. Rotational techniques are emphasized. Research is needed in which the theoretical basis for the selection of treatment for patients presenting with a clinically relevant asymmetric rotation is described and critically analyzed.