6. Sistema de Peter O’Sullivan
Kappa Concordancia
87 - 98 Muy Buena
Vibe Fersum K et al., Inter-examiner reliability of a classification system
for patients with non-specific low back pain,
Manual Therapy (2008), doi:10.1016/j.math.2008.08.003
7. SDL
Vibe Fersum K et al., Inter-examiner reliability of a classification system for patients with non-specific low back pain, Manual Therapy (2008),
doi:10.1016/j.math.2008.08.003
O’Sullivan P. Diagnosis and classification of chronic low backpain disorders: Maladaptive movement and motor control impairments as underlying
mechanism. Manual Therapy 10 (2005) 242–255
8. DETERIORO DEL MOVIMIENTO
• Dolor de rápida aparición
• El movimiento está alterado
en la dirección del dolor
• Reflejo motor de retirada
exagerado
• Contractura muscular y
carga anormal de tejidos
(aumento estabilidad)
• Evitación del movimiento en
el rango doloroso
• Creencia que el dolor daña
Vibe Fersum K et al., Inter-examiner reliability of a classification system for patients with non-specific low back pain, Manual Therapy (2008),
doi:10.1016/j.math.2008.08.003
O’Sullivan P. Diagnosis and classification of chronic low backpain disorders: Maladaptive movement and motor control impairments as underlying
mechanism. Manual Therapy 10 (2005) 242–255
9. DETERIORO DEL MOVIMIENTO
(regla de predicción clínica)
• Duración de los síntomas
menos de 16 días
• Localización que no
sobrepase distalmente a la
rodilla
• ROM de Rot Med. De cadera
>35º al menos en 1 cadera
• Hipomovilidad lumbar en
sitio doloroso
• Fear-Avoidance Beliefs
Questionnaire <18
Fritz JM, Whitman JM, Flynn TW, et al. Factors related to the inability of individuals with low back pain to improve
with a spinal manipulation. Phys Ther. 2004;84:173–190.
10. DETERIORO DEL CONTROL
• Aparición gradual del dolor
• no hay alteración del movimiento
en la dirección del dolor
• Falta de trigger-points
• Pobre sentido de la posición y
control lumbopélvico
• Ausencia del reflejo de retirada
• Distención de tejidos
• (falta de estabilidad)
• Evitación de la actividad dolorosa
• Creencia que la actividad daña
Dankaerts W, O'Sullivan PB, Burnett AF, Straker LM. The use of a mechanism-based classification system to evaluate and direct management of a
patient with non-specific chronic low back pain and motor control impairment—A case report. Manual Therapy 12 (2007) 181–191
Vibe Fersum K et al., Inter-examiner reliability of a classification system for patients with non-specific low back pain, Manual Therapy (2008),
doi:10.1016/j.math.2008.08.003
O’Sullivan P. Diagnosis and classification of chronic low backpain disorders: Maladaptive movement and motor control impairments as underlying
mechanism. Manual Therapy 10 (2005) 242–255
11. DETERIORO DEL CONTROL
(regla de predicción clínica)
• Edad >40 años
• SLR >91º
• Movimiento aberrante
presente
• Test de inestabilidad en
prono positivo
Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low
back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 2005; 86:1753-62
12. McGill S. Low Back Disorders. Evidence-Based Prevention and Rehabilitation . 2nd Edition. 2007
14. TRATAMIENTO
Deterioro del movimiento Deterioro del control
Vicenzino B, Paungmali A, Teys P. Mulligan’s mobilization-with-movement, positional faults and pain relief: Current concepts from a critical review of
literature . Manual Therapy 12 (2007) 98–108
McGill SM, Karpowicz A. Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Arch Phys Med Rehabil
2009;90:118-26