Classification Systems for Spinal Disorders
A key point with classification systems is that they are used by physical therapists as a framework to guide clinical-decisions. Following an examination, a physical therapist may use a classification (e.g., "Flexion-Bias" or "Postural Syndrome" to identify a PT diagnosis that guides treatment
McKenzie Method
Most common classification system for low back pain used in physical therapy
Patients are classified as having mechanical pain (reproduced with movement) or non-mechanical (associated with inflammation or other pathology)
Results of PT examination leads toward categorization of mechanical low back pain. Patients with neuromuscular findings are generally not included in a McKenzie classification system
Specific elements of the PT examination include:
- history
- posture
- movement testing (standing, sitting, prone, prone, etc.); repeated and sustained movements/positions
- pain with movement
- palpation and joint mobility
- range of motion
Movement testing
Lumbar motion tests are performed in straight planes and with combined motions
The PT monitors symptom location and intensity with sustained and repeated motions
centralization: pain presents proximally and in the spine
peripheralization: pain presents proximally and radiates laterally and distally with movement
Following the examination, patients are can be placed in one of three (3) syndromes:
- Postural
- Dysfunction
- Derangement
Treatment-Based Classification
Determines if the patient can be managed by PT alone or requires MD or other health care provider involvement. Delitto using descriptions to classify intervention approaches for the spine based on what reduces symptoms and is most likely to allow progression. Using Delitto's system, spine conditions are classified as needing: (1) immobilization, (2) mobilization, (3) specific exercises, or (4) traction.
In general, treatment-based classifications use directional preference for movement and symptom modulation as a way to develop interventions to restore function.
Movement-Based Impairment (Sahrmann)
This system assesses postural and spinal changes in static positions and with limb motion in a variety of positions. Patients are classified based on the direction of motion which reproduces the pain complaint and compensatory strategies. Treatment emphasis is on restoring normal muscle length/balance and eliminating compensatory strategies.
