Movement system impairment-based categories for low back pain: stage 1 validation

J Orthop Sports Phys Ther. 2003 Mar;33(3):126-42. doi: 10.2519/jospt.2003.33.3.126.


Study design: Cross-sectional study of patients with mechanical low back pain (MLBP).

Objective: To test the construct validity of 3 categories of a movement system impairment-based classification proposed for use with patients with MLBP.

Background: A pathoanatomic basis for directing treatment has not proven useful in a wide variety of patients with MLBP. In addition, there is a paucity of data describing the movement system impairments that characterize many of the pathoanatomically based MLBP diagnoses. Because of the mechanical nature of MLBP, a system based on groups of signs and symptoms relevant to conservative management needs to be developed.

Methods and measures: A movement system impairment-based classification was proposed that defined 5 categories of MLBP based on the findings from a standardized examination. Using the examination, 5 physical therapists examined a total of 188 patients with MLBP. A principal components analysis with an oblique rotation was conducted. Eigenvalues were plotted and a scree test was used to determine the number of factors to retain. A split-sample cross-validation procedure was conducted to verify the factor structure.

Results: Three factors were identified in both samples: 2 factors related to symptoms with lumbar rotation and lumbar extension alignments or movements, and 1 factor related to signs of lumbar rotation with different alignments and movements.

Conclusion: Our results provide support for 3 factors related to 3 of the 5 proposed categories: lumbar rotation with extension, lumbar rotation, and lumbar extension. The existence of these 3 factors provides preliminary evidence for specific clusters of tests of alignment and movement impairments that could be used in classifying patients with MLBP into movement-system-related categories.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Low Back Pain / classification*
  • Low Back Pain / physiopathology
  • Low Back Pain / rehabilitation
  • Lumbosacral Region / physiopathology*
  • Male
  • Middle Aged
  • Movement / physiology*
  • Physical Examination / methods*
  • Posture / physiology
  • Reproducibility of Results
  • Rotation*