Classification of lumbopelvic pain disorders--why is it essential for management?

87 NC OR RE CT The majority of lumbopelvic pain disorders have no diagnosis leaving a management vacuum. The classification of lumbopelvic pain disorders into subgroups is considered one of the greatest challenges, so as to enable the application of specific and effective interventions. It is well acknowledged that chronic lumbopelvic pain disorders are complex and multi-dimensional in nature. These disorders are commonly associated with changes in neurophysiology, altered motor control, psychological factors such as fear and anxiety, faulty coping strategies, social impact and in some cases pathoanatomical factors (Waddell, 2004). There is considerable debate as to the significance of these different factors and what is cause and effect. There is a growing focus within physiotherapy to treat motor control impairments associated with these disorders. Altered motor control in CLBP disorders is complex, highly variable and individual in nature. Trunk motor control is influenced by: spinal–pelvic posture, movement, stability demand, respiration and continence demand as well as neurophysiological factors, pathology and various psychological factors. Altered motor control may be adaptive (protective) or mal-adaptive (provocative). It can result in excessive spinal stability and increased spinal loading (due to muscle guarding and splinting) or reduced spinal stability (inhibition of spinal stabilizing muscles) leading to pain (O’Sullivan, 2005). It is proposed that there are three main groups that present with chronic disabling lumbopelvic pain with regard to motor control impairments (O’Sullivan, 2005). U 89