First international sports physiotherapy congress organised by The Finnish Sports Physiotherapists Association FSPA., At Finlandia Hall, March 2015. Author Tomi Korpi.

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IDENTIFYING AND RESTORING
UNCONTROLLED LUMBAR MOVEMENT IN
CHRONIC LOW BACK PAIN
Conference Paper · March 2015
DOI: 10.13140/RG.2.1.3099.9764
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2. IDENTIFYING AND RESTORING
UNCONTROLLED LUMBAR
MOVEMENT IN CHRONIC
LOW BACK PAIN
1 BACKGROUND
Chronic low back pain is a common problem. Pain is always
subjective and influenced by physiological, cognitive, and
social factors (2).
Up to 30% of low back pain (LBP) patients are estimated to
have MCI (3). Restoration of neuromuscular control in
lumbar back is motor learning (4). Evidence suggests the
use of social cognitive learning theory in chronic pain
rehabilitation (5). According to the learning theory, the
instructor in motor skill education is recommended to aim at
changing the learner’s mental and physical skill models and
developing the problem-solving skills (4). Multiple
informational sources are needed, e.g. observational
learning and understanding of the instructed facts (5). So far
the value of patients own understanding of the problem
might be underestimated.
2 MATERIALS AND METHODS
Four (N=4) patients of working age(29-61-year-old)
participated in this feasibility study. Their lumbar movement
control was diagnosed with the movement control tests (7;
table 1) and patient education and guiding were examined
subjectively in two physiotherapy visits.
Individual therapeutic exercises done regularly by the patient are shown to be effective in
treating different kinds of movement control impairments (MCI). According to self-efficacy
theory (1,6) the patient need to identify the problem, understand the mechanism, visualize
and then exercise, in order to restore the working behavior - the movement control.
Their comprehension about an uncontrolled lumbar
movement, physiotherapist guiding, and factors affecting
therapeutic exercises were surveyed with the aid of enquiry
and interview forms.
3 RESULTS
Patients differentiated uncontrolled lumbar movement from
controlled movement fairly well (avg. 68%) from pictures
(picture 1). Patients identified their own uncontrolled lumbar
movement poorly (36%) (table 2) and they had very different
conceptions about the meaning of uncontrolled lumbar
movement. On average the controlling of the lumbar
movement improved 17% (40% -> 57%) during the 86 days
(table 1). All patients experienced that the physiotherapy
guidance was the most advancing factor in executing the
therapeutic exercises (picture 2).
4 CONCLUSIONS
Patients’ uncontrolled lumbar movement got better although
they didn't recognize the uncontrolled lumbar movement or
its direction correctly (table 1;2).
Therapeutic guidance was experienced important by patients
(picture 2), which is in line with previous studies.
This study shows that the patients need the physiotherapist
guiding in hope of restoring the movement control of lumbar
spine.
5 IMPLICATIONS
Study suggests to assess the instructed facts. It also shows
the need for improving the dialogue between the patient and
the instructor in order to help patient’s understanding of
guiding. Interventions are needed to improve patients
observational learning in lumbar movement control e.g. by
converting modeled activity into codes that symbolize it (5).
Tomi Korpi PT1, Anna-Maija Jäppinen MSc2
1 HUCH Internal Medicine and Rehabilitation, Physiotherapy Jorvi, Espoo, Finland; tomi.korpi@hus.fi
2 HUCH Internal Medicine and Rehabilitation, Helsinki, Finland
TABLE 1. Qualified movement control tests (7)
when diagnosed and on the second visit.
PICTURE 1. Identifying own lumbar movement as the
physiotherapist educated from pictures (14) was poor,
but recognizing correct movement was good.
TABLE 2. Identifying movement control and impairment and
recognizing own movement.
PICTURE 2. Advancing therapeutic exercise factors
experienced by patients. No. 4 “I got help from home
or from close friends“ and no. 6 “some other reason”
weren’t experienced advancing therapeutic exercise.
REFERENCES
1. Resnick B. 2008. Theory of Self-Efficacy. In Smith MJ & Liehr PR. Middle
Range Theory for Nursing. New York, NY, USA: Springer Publishing Company,
2nd edition. p. 183-198
2. Taimela S. Selkävaivat. 2010. In Vuori I, Taimela S, Kujala U.
Liikuntalääketiede. 3-4th edition. Kustannus oy Duodecim. p. 311-312
3. O’Sullivan P. Diagnosis and classification of chronic low back pain dis-
orders: Maladaptive movement and motor control impairments as underly-
ing mechanism. Manual Therapy 2005; 10. p.242‐255
4. Kauranen K. 2011. Motoriikan säätely. Tammerprint. Tampere. p. 119, 135, 144,
154, 291
5. Nash VR, Ponto J, Townsend C, Nelson P, Bretz MN. Cognitive behavioral
therapy, self-efficacy, and depression in persons with chronic pain. Pain Manag
Nurs. 2013 Dec;14(4):e236-43.
6. Bandura A. 1997. Self-efficacy: The exercise of control. 1st edition. Worth
Publishers. p. 79-113, 370-383
7. Luomajoki H. 2010. Movement Control Impairment as a Sub-group of Non-
specific Low Back Pain. Doctoral thesis, University of Eastern Finland.
ACKNOWLEDGEMENTS
Patients and staff for participating in this study.
The HUCH Department of Surgery approved this study. Written
informed consent was obtained together with verbal consent from the
patients before participation.
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