Resources and Strategies

The Evidence-Informed Chiropractor


Week 12 - Functional Testing - Need for Low Back Rehabilitative or Preventive Exercises



Can you determine weaknesses that may predispose your patients to low back pain?


• A protocol in common use is a screening approach to evaluating strength and endurance proposed and based on studies by McGill, Rissanen, Alaranta, Schellenberg, and others.
• The observation from these studies is that simple in-office testing has some predictive value and, in place of more expensive isokinetic testing, provides a level of evidence for screening patients to determine specific weakness in either endurance or strength that can be used to prescribe rehabilitative exercises.
• Age and gender based normative data is used to then categorize the patient into one of five categories with five being excellent, four-good, three-moderate, two-poor, and 1-extremly poor (see McGill S. Low Back Pain Disorders)
  • Rissanen A, Alaranta H, Sainio P, Harkonen H. Isokinetic and non-dynamometric tests in low back pain patients related to pain and disability index. Spine. Sep 1 1994;19(17):1963-1967.
  • Alaranta H, Luoto S, Heliovaara M, Hurri H. Static back endurance and the risk of low-back pain. Clin Biomech (Bristol, Avon). Sep 1995;10(6):323-324.
  • Schellenberg KL, Lang JM, Chan KM, Burnham RS. A clinical tool for office assessment of lumbar spine stabilization endurance: prone and supine bridge maneuvers. Am J Phys Med Rehabil. May 2007;86(5):380-386.
  • Barr KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, Part 1. Am J Phys Med Rehabil. Jun 2005;84(6):473-480.
  • Barr KP, Griggs M, Cadby T. Lumbar stabilization: a review of core concepts and current literature, part 2. Am J Phys Med Rehabil. Jan 2007;86(1):72-80.
  • McGill S. Low Back Disorders: Evidence-Based Prevention and Rehabilitation: 3rd ed. Champaign, IL: Human Kinetics; 2007.

Functional Testing

• Side-bridge (right and left) – patient supports themselves on one side with a flexed elbow and crossed feet (support at ankles). Generally should be held for about 1 to 1 ½ minutes in healthy young individuals

• Flexion – patient is supine and supported by a jig or other device at 55 degrees with hips and knees flexed to 90 degrees. With the support removed the patient is asked to hold the position for as long as possible. Average is about two minutes in young health individuals

• Extension (same as static back endurance test above) – patient is supported at the ankles or lower legs in a prone position with the trunk off of a high table. They are asked to hold a horizontal position to the ground with the arms crossed over the chest for as long as possible. The average for healthy young individuals is about 2 ½ to 3 minutes.

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