A literature review of clinical tests for lumbar instability in low back pain: Validity and applicability in clinical practice

Silvano Ferrari, Tiziana Manni, Francesca Bonetti, Jorge Hugo Villafañe, Carla Vanti

Research output: Contribution to journalArticlepeer-review


Background: Several clinical tests have been proposed on low back pain (LBP), but their usefulness in detecting lumbar instability is not yet clear. The objective of this literature review was to investigate the clinical validity of the main clinical tests used for the diagnosis of lumbar instability in individuals with LBP and to verify their applicability in everyday clinical practice. Methods: We searched studies of the accuracy and/or reliability of Prone Instability Test (PIT), Passive Lumbar Extension Test (PLE), Aberrant Movements Pattern (AMP), Posterior Shear Test (PST), Active Straight Leg Raise Test (ASLR) and Prone and Supine Bridge Tests (PB and SB) in Medline, Embase, Cinahl, PubMed, and Scopus databases. Only the studies in which each test was investigated by at least one study concerning both the accuracy and the reliability were considered eligible. The quality of the studies was evaluated by QUADAS and QAREL scales. Results: Six papers considering 333 LBP patients were included. The PLE was the most accurate and informative clinical test, with high sensitivity (0.84, 95% CI: 0.69 - 0.91) and high specificity (0.90, 95% CI: 0.85 -0.97). Conclusions: The data from the studies provided information on the methods used and suggest that PLE is the most appropriate tests to detect lumbar instability in specific LBP. However, due to the lack of available papers on other lumbar conditions, these findings should be confirmed with studies on non-specific LBP patients.

Original languageEnglish
Article number14
JournalChiropractic and Manual Therapies
Issue number1
Publication statusPublished - Apr 8 2015


  • Aberrant movements pattern
  • Joint instability
  • Low back pain
  • Lumbar instability
  • Passive lumbar extension test
  • Physical examination
  • Posterior shear test
  • Prone instability test
  • Reproducibility of results

ASJC Scopus subject areas

  • Complementary and alternative medicine
  • Chiropractics
  • Physical Therapy, Sports Therapy and Rehabilitation

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