Which Low Back Instability Tests Should Be Incorporated Into a Stabilization Classification Exam for Athletes?: A Critically Appraised Topic

in International Journal of Athletic Therapy and Training
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $74.00

1 year subscription

USD  $99.00

Student 2 year subscription

USD  $141.00

2 year subscription

USD  $188.00

Clinical Question: Is there sufficient evidence to determine which low back instability tests should be incorporated into a stabilization classification exam for athletes? Clinical Bottom Line: There is moderate level 2 evidence to include, but not to use in isolation, the prone instability test along with other instability tests in a stabilization classification exam.

The author (msandrey@mail.wvu.edu) is an associate professor in the College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, WV, USA.

  • 1.

    Bauer CM, Heimgartner M, Rast FM, Ernst MJ, Oetiker S, Kool J. Reliability of lumbar movement dysfunction tests for chronic low back pain patients. Man Ther. 2016;24:81–84. PubMed ID: 26980560 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Hicks GE, Fritz JM, Dellitto A, Mishock J. Intertater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84:1858–1864. PubMed ID: 14669195 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290–302. PubMed ID: 17612355 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Foss IS, Holme I, Bahr R. The prevalence of low back pain among former elite cross-country skiers, rowers, orienteerers, and nonathletes: a 10-year cohort study. Am J Sports Med. 2012;40(11):2610–2616. PubMed ID: 22972850 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Teitz CC, O’Kane J, Lind BK, Hannafin JA. Back pain in intercollegiate rowers. Am J Sports Med. 2002;30(5):674–679. PubMed ID: 12239000 doi:

  • 6.

    Fritz JM, Clifford SN. Low back pain in adolescents: a comparison of clinical outcomes in sports participants and nonparticipants. J Athl Train. 2010;45(1):61–66. PubMed ID: 20064050 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Baeza-Velasco C, Gely-Nargeot MC, Pailhez G, Vilarrasa AB. Joint hypermobility and sport: a review of advantages and disadvantages. Curr Sports Med Rep. 2013;12(5):291–295. PubMed ID: 24030301 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Corkery MB, O’Rourke B, Viola S, et al. An exploratory examination of the association between altered lumbar motor control, joint mobility and low back pain in athletes. Asian J Sports Med. 2014;5(4):e24283. PubMed ID: 25741418

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Jacobs JV, Henry SM, Jones SL, Hitt JR, Bunn JY. A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. J Neurophysiol. 2011;106:2506–2514. PubMed ID: 21795622 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Ferrari S, Vanti C, Piccarreta R, Monticone M. Pain, disability, and diagnostic accuracy of clinical instability and endurance tests in subjects with lumbar spondylolisthesis. J Manipulative Physiol Ther. 2014;37(9):647–659. PubMed ID: 25282678 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Ravenna MM, Hoffman SL, Van Dillen LR. Low interrater reliability of examiners performing the prone instability test: a clinical test for lumbar shear instability. Arch Phys Med Rehabil. 2011;92(6):913–919. PubMed ID: 21621668 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Vanti C, Conti C, Faresin F, Ferrari F, Piccaretta F. The relationship between clinical instability and endurance tests, pain, and disability in nonspecific low back pain. J Manipulative Physiol Ther. 2016;39(5):359–368. PubMed ID: 27167368 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Fritz JM, Whitman JM, Childs JD. Lumbar spine segmental mobility assessment: an examination of validity for determining intervention strategies in patients with low back pain. Arch Phys Med Rehabil. 2005;86(9):1745–1752. PubMed ID: 16181937 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Fritz JM, Piva SR, Childs JD. Accuracy of the clinical examination to predict radiographic instability of the lumbar spine. Eur Spine J. 2005;14:743–750. PubMed ID: 16047211 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Delitto A, Erhard RE, Bowling RW. A treatment based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther. 1995;75:470–485. PubMed ID: 7770494 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Kasai Y, Morishita K, Kawakita E, Kondo T, Uchida A. A new evaluation method for lumbar spinal instability: passive lumbar extension test. Phys Ther. 2006;86(12):1661–1667. PubMed ID: 17033040 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Whiting PF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt NM, Kleijnen J. Evaluation of the QUADAS, a tool for the quality assessment of diagnostic accuracy studies. MRC Med Res Methodol. 2006;6:9–16. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69(3):548–556.

    • Search Google Scholar
    • Export Citation
  • 19.

    Rabin A, Shashua A, Pizem K, Dickstein R, Dar G. A clinical prediction rule to identify patients with low back pain who are likely to experience short-term success following lumbar stabilization exercises: a randomized controlled validation study. J Orthop Sports Phys Ther. 2014;44:6–B13. PubMed ID: 24261926 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 395 395 262
Full Text Views 39 39 18
PDF Downloads 11 11 6