A variety of movement impairments emerge with different low back conditions. These Restriction Patterns can be grouped into multidirectional impairments, directional impairments or combinations of both multidirectional and directional impairments.
Movement loss of a similar magnitude in all directions demonstrates a multidirectional impairment.
Mild, moderate and severe degrees of impairment are indicated by the extent of shading.
This type of multidirectional impairment may include chronic pain conditions (with hyperalgesia or allodynia) and generalised inflammatory conditions that include disc inflammation.
Directional impairments demonstrate an obvious movement limitation in one direction.
There are three main patterns of directional impairments.
- flexion impairments
- extension impairments
- lateral impairments.
A disc prolapse may force asymmetrical postures to be adopted for symptomatic relief.
- Pain and restriction is noticed when the back is flexed. ie stretching forward or rolling the pelvis backwards.
- This may occur after a muscle or ligament strain when sensitive structures become stretched.
- Chronic bending (flexion) can also increase the sensitivity of structures including the disc and posterior elements.
- Movements backwards (extension) are not stretching sensitive structures and are pain free.
- Pain and restriction when bending backwards (extension) or rolling the pelvis forwards.
- This pattern tends to occur with conditions such as spinal stenosis and spondylolythesis.
- Pain and restriction when bending or twisting to one side such as a lateral disc protrusion or facet joint pain.