Lumbar Instability

Lumbar Instability Is An Important Cause Of Chronic Back Pain

According to a 2005 study in the European Spine Journal lumbar instability is prevalent in up to 57% of patients with chronic low back pain. Radiographic examination has been the standard for identifying these patients.

Excessive motion like translation and/or rotation of at least one lumbar segment is a critical characteristic finding. Delayed diagnosis may result in the need for surgery with or without spinal fusion. Diagnosis of using x-ray examination poses some limitations, like time and cost, access to equipment, and radiation exposure. Early detection of lumbar instability enables timely noninvasive treatment, helping to prevent further structural degeneration.

lumbar instability

Stability of the lower back is the ability to maintain a stable neutral zone of the lumbar spine. According to the activity and function, the core muscles responsible for stabilization be categorized into two main groups. The superficial or global muscles are the primer movers of the trunk, while the deep or local muscles provide a stiffening effect through attaching to the thoracic and lumbar fascia and play important roles in segmental stability.

Questionnaires tailored for particular conditions can provide diagnostic assistance and can measure treatment progress. They are beneficial where there is insufficient equipment, and do not require professional skills to administer.

Back Stability Questionnaire

The study indicates a score less than 7 rules out instability, while a score of 7 or more requires further investigation and evaluation.

1. You feel like back has collapsed


2. You feel better with self-manipulation


3. Your  back pain symptoms come and go all the time


4. You have a history of complaints of stiffness and sudden back pain when twisting or bending


5. Your back pain has been provoked by changing posture, for example standing up from sitting, etc.


6. You have increased back pain when returning to upright after forward bending


7. Sudden or minor movements increase your back pain


8. Pain gets worse when sitting on a chair without a backrest and gets better when sitting on a chair with backrest


9. You have increased back pain when you are in one posture for a long time


10. Your back pain is worsening


11. Your back pain temporarily relieved when wearing a brace


12. You frequently experience back muscle spasms


13. You are afraid or hesitant to move when experiencing back pain


14. You have a past history of back pain or injury


Question 1 of 14

lumbar spine stabilization at amazon

Patients with chronic low back pain often demonstrate problems with these local stabilization muscles, like as atrophy, fatty infiltration and activation delay. This can make anticipatory postural adjustments difficult and may eventually result in damage to the spine. One of these muscles is the transverse abdominal muscle.

For mild levels of instability, stabilization exercises can help. Home core stabilization exercises are easily employed and can reverse or prevent progressive deterioration that may lead to surgery. A good stabilizing back brace should be used when performing daily activities that can stress or further injure the lower back.

A 2021 study in International Journal of Environmental Research and Public Health indicates core stabilizing exercises with a focus on increasing the activity of the deep trunk muscles can reduce lumbar segmental translation (excessive motion) and should be recommended for lumbar instability.

The questionnaire is a subjective measure of instability and with positive results, confirmation can be obtained. Clinical instability requires specific radiographic measurements take in flexion and extension. The above study indicates this should be done while lying on the side to to avoid the influence of muscle bracing and pain aggravation.

instability signsA 2022 study in Scientific Reports indicates that bone spurs and vacuum phenomenon (gas in disc) seen on radiographs may be a sign of lumbar intervertebral instability.

A study in the journal Neurologist found vacuum phenomenon was related to morning lower back pain, pain when standing up or rolling over, and was influenced by changes in the weather.

For moderate to severe levels, professional assistance is advised. Further investigation is warranted for possible non-invasive or invasive methods to provide solutions.

A 2023 study in BMC Musculoskeletal Disorders found The extent of Modic changes lesion involvement are strongly associated with lumbar instability and that higher body mass index might be a risk factor for the development of severe lesions.

The screening tool questionnaire is based on a 2020 study in the journal Spine.

Author Bio

Stephen Ornstein, D.C. has treated thousands of neck, shoulder and back conditions since graduating Sherman Chiropractic College in 1987 and during his involvement in Martial Arts. He holds certifications as a Peer Review Consultant from New York Chiropractic College, Physiological Therapeutics from National Chiropractic College, Modic Antibiotic Spinal Therapy from Dr. Hanne Albert, PT., MPH., Ph.D., Myofascial Release Techniques from Logan Chiropractic College, and learned Active Release Technique from the founder, P. Michael Leahy, DC, ART, CCSP.