Search Results (196)

Background and Objectives: This research aimed to compare Type D personality characteristics and self-esteem between individuals with chronic NSLBP and healthy controls, while also exploring their relationships with functional status, psychological symptoms, and quality of life within the patient group. Materials and Methods: In this cross-sectional investigation, 34 patients with chronic NSLBP were compared with 34 healthy controls with similar age and sex distribution. Pain intensity was quantified via the Visual Analog Scale (VAS), while functional impairment was evaluated using the Oswestry Disability Index (ODI). Psychological profiling included the Type D Scale-14 (DS14) for personality traits, the Rosenberg Self-Esteem Scale (RSES) for self-worth, and the Hospital Anxiety and Depression Scale (HADS) for emotional distress. Health-related quality of life was captured through the 12-Item Short Form Health Survey (SF-12). Results: Type D personality was significantly more prevalent in the NSLBP group than in controls (50% vs. 20.6%, p = 0.011). Patients with NSLBP had significantly higher negative affectivity (NA) scores (p < 0.001) and anxiety scores (p = 0.007) and lower SF-12 Physical Component Summary scores (p < 0.001) than controls. Pain intensity and disability were positively correlated with Type D personality traits, particularly NA and the Type D composite score. In exploratory subgroup analyses, patients with Type D personality also had higher pain intensity, disability, anxiety, and depression scores and lower SF-12 Mental Component Summary (MCS) scores than those without Type D personality. In adjusted regression analyses within the NSLBP group, Type D personality was associated with higher VAS (p = 0.004) and ODI scores (p = 0.007) and lower SF-12 MCS scores (p = 0.003). Conclusions: Type D personality characteristics were more frequent in patients with chronic NSLBP than in healthy controls and were associated with higher pain intensity, greater disability, higher anxiety and depressive symptom scores, and poorer mental quality-of-life scores within the patient group. In contrast, self-esteem did not differ significantly between patients and controls. Due to the inherent constraints of a cross-sectional framework and the potential construct redundancy between NA and emotional distress, the current results signify correlational links rather than definitive causality. Consequently, subsequent prospective research is vital to delineate the temporal dynamics and the long-term predictive value of Type D personality traits in the progression of chronic NSLBP. Full article

Background: Chronic nonspecific low back pain (CNLBP) with lumbar hyperlordosis leads to pain, dysfunction, and poor quality of life. Virtual reality (VR)-based training may enhance exercise engagement and outcomes. This study compared VR-based pelvic rocking training with conventional pelvic rocking training exercises. Methods: A triple-blind randomized controlled trial enrolled 100 participants with CNLBP and hyperlordosis, who were randomly allocated into two groups: the group, which performed pelvic rocking exercises using the TBed VR system (TbG), and the conventional group (CG), which performed the same exercises without VR. Both groups completed three sessions per week for eight weeks. Primary outcomes included pain (Numerical Pain Rating Scale, NPRS), lumbar lordotic angle (LLA), lumbar range of motion (ROM), and functional disability (Oswestry Disability Index, ODI). Secondary outcomes were patient satisfaction and commitment to exercise sessions. Assessments were conducted at baseline, immediately post-intervention, and after a one-month follow-up. Results: Both groups showed significant improvements in all outcome measures post-treatment (p < 0.016). Furthermore, some outcomes—specifically pain, LLA, and extension ROM—continued to improve during the follow-up period. The TbG demonstrated significantly greater reductions in pain, greater ROM improvements, greater functional gains, and higher levels of satisfaction and commitment than the CG (p < 0.05). These between-group differences persisted at the one-month follow-up, particularly for pain and ROM, which remained statistically significantly better in the TbG. Moreover, all between-group differences demonstrated medium to high clinical effects (d ≥ 0.3). Conclusions: Pelvic rocking exercises using the TBed VR system were superior to conventional exercises in terms of pain, ROM, and function at the immediate and intermediate time points. Using TBed led to better patient satisfaction and higher exercise commitment. Full article

Background: Musculoskeletal pain affects an estimated 1.7 billion people worldwide and ranks among the leading causes of global disability. This review evaluates the effectiveness and safety of osteopathy in treating musculoskeletal pain across multiple body regions and conditions. Methods: A systematic literature review following PRISMA guidelines was conducted across five databases (Embase, Medline via Ovid, The Cochrane Library, PEDro, and INAHTA), yielding 964 citations. Eligible studies were RCTs published in English or German up to May 2022; conference abstracts were excluded. A hybrid design was employed: a systematic review of RCTs for neck, shoulder, knee, foot, osteoporosis, and fibromyalgia was combined with a pre-specified umbrella review component for chronic non-specific low back pain (registered in PROSPERO) to avoid duplication of an existing high-confidence evidence synthesis. From 35 critically appraised articles, the best available evidence (n = 15) was selected per body region based on a risk of bias (RoB) assessment (Cochrane Collaboration tool, version 1); the existing review was appraised with AMSTAR 2. An updated search (2022–July 2025) was performed without a RoB assessment. Data were synthesised qualitatively and reported narratively. Results: Fifteen RCTs and one systematic review were included, covering eight body regions and conditions (2408 participants). Pain improved immediately post-treatment in most regions; statistically significant between-group differences were less consistent at mid- and long-term follow-ups. Key findings: neck pain (n = four RCTs)—improvement in three of four studies immediately post-treatment; shoulder pain (n = two RCTs)—improvements across all follow-up points in one study; low back pain (n = one systematic review, 10 RCTs, 1160 participants)—pain reduced immediately and at mid-term follow-up; knee pain (n = two RCTs)—significant reduction in one study; foot pain (n = two RCTs)—improvement in both studies post-treatment and at mid-term follow-up; osteoporosis (n = one RCT)—no improvement immediately post-treatment; fibromyalgia (n = two RCTs)—significant between-group differences in one study post-treatment and at mid-term follow-up. Functional outcomes were heterogeneous across regions. Adverse events were minor and transient; no serious side effects were reported across any included study. The updated search (2022–July 2025) identified 12 additional RCTs across five regions, with findings broadly consistent with the primary analysis, though results for the neck region were marginally less favourable. Discussion: Based on current evidence, osteopathy can improve neck and low back pain for up to three months and may reduce shoulder and foot pain; evidence for other body regions remains inconclusive. RoB was unclear to high across studies, largely due to the inherent inability to blind patients and practitioners in manual therapy trials. Substantial heterogeneity in interventions, outcome measures, and study designs limits comparability. Overall certainty of evidence was low to moderate, warranting cautious interpretation. The consistent absence of serious adverse events across all included studies supports osteopathy as a safe therapeutic option. High-quality research with standardised interventions, rigorous designs, long-term follow-ups, and a focus on technique, dosage, and safety is needed to inform clinical practice and healthcare policy. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector. Full article

Background and Objectives: To assess the reliability and construct validity of the Functional Rating Index (FRI) in Italian-speaking individuals with chronic non-specific low back pain (CLBP), in order to improve assessment and clinical management in this population. Materials and Methods: This cross-sectional study consecutively enrolled 75 individuals with CLBP (52 females; mean age 48.71 ± 19.18 years; mean pain duration 298.64 ± 427.52 weeks). Internal consistency and test–retest reliability were evaluated using Cronbach’s α and the intraclass correlation coefficient [ICC_2,1], respectively, while measurement error was estimated through the minimum detectable change (MDC). Construct validity was examined by testing a priori hypotheses through correlations (Pearson’s r) between the FRI and disability measures (Roland–Morris Disability Questionnaire, RMQ; Oswestry Disability Index, ODI), pain intensity (Numerical Rating Scale, NRS), and quality of life (Short-Form Health Survey, SF-36). Results: Cronbach’s α was 0.88, and test–retest reliability showed an ICC_2,1 of 0.86 (95%CI: 0.82–0.93). The MDC was 18.05, corresponding to approximately 20% of the total score. The Italian FRI demonstrated strong correlations with the RMQ (r = 0.70) and ODI (r = 0.77), and a moderate correlation with the NRS (r = 0.60). The physical and social domains of the SF-36 showed stronger negative correlations with the FRI than the mental and emotional domains. Conclusions: The Italian version of the FRI is a reliable and valid instrument for individuals with CLBP and is recommended for both clinical practice and research applications. Full article

Objectives: This study aimed to evaluate the effectiveness and safety of paracetamol 1000 mg/ibuprofen 300 mg administered three times daily (TID) in comparison with ibuprofen 600 mg TID in the management of patients with acute moderate/severe non-specific low back pain (LBP). Methods: This was a phase IV, randomized, open-label, parallel-group study conducted in adults with moderate/severe LBP (Visual Analogue Scale [VAS] score ≥ 40 mm). Results: A total of 171 patients were included in the modified intention-to-treat (m-ITT) population (paracetamol 1000 mg/ibuprofen 300 mg: 83 patients; ibuprofen 600 mg: 88 patients). No significant between-group difference on the primary endpoint (SPID 0–3 days) was found. Patients were mainly women (60.2% and 55.7%), with a mean age of 42.8 and 43.3 years, respectively. In the m-ITT population, the effectiveness, safety and tolerability were similar between groups. In the per-protocol population, clinical pain reduction was observed with paracetamol 1000 mg/ibuprofen 300 mg. At visit 1, significant differences in the Clinical Global Impression–Improvement scale (paracetamol 1000 mg/ibuprofen 300 mg: 63.9%; ibuprofen 600 mg: 45.5%; p = 0.0137) and a trend favouring paracetamol 1000 mg/ibuprofen 300 mg in Patients’ Global Impression of Change (63.9% vs 44.4%; p = 0.0539) score were observed. Conclusions: Given the open-label design and the exploratory nature of study’s secondary endpoints, no claims of superiority can be drawn; but our findings confirm that good management of acute moderate/severe LBP can be achieved with multimodal therapy with paracetamol 1000 mg/ibuprofen 300 mg. EudraCT Number: 2020-005278-86 (EudraCT Number 2020-005278-86—Clinical trial results—EU Clinical Trials Register; date of registration: 14 June 2021). Full article

Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide and remains clinically challenging due to its marked heterogeneity and limited correlation between structural pathology and symptoms. Increasing evidence suggests that neuroinflammatory mechanisms and central sensitization (CS) contribute to pain persistence in a clinically relevant subset of patients. This narrative review critically evaluates the current evidence on neuroinflammatory biomarkers in CLBP and discusses their translational potential for mechanism-based patient stratification. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Google Scholar using terms related to neuroinflammation, biomarkers, CLBP, CS, and glial activation. Studies were preferentially selected according to the following hierarchical criteria: (1) human studies directly investigating neuroinflammatory biomarkers in CLBP; (2) mechanistic human imaging or cerebrospinal fluid studies; (3) translational preclinical investigations providing direct mechanistic relevance; and (4) high-quality systematic reviews providing synthesis of biomarker evidence. As this was a narrative review, study selection was guided by conceptual relevance and translational significance rather than by formal systematic review methodology. Results: Converging evidence supports the involvement of neuroinflammatory processes in subgroups of patients with CLBP. In vivo TSPO-PET imaging and experimental data support glial activation in pain-processing regions. Cerebrospinal fluid studies report elevated chemokines, particularly interleukin-8 and monocyte chemoattractant protein-1, highlighting periphery-to-central nervous system inflammatory cross-talk and the concept of compartmentalized neuroinflammation. In parallel, epigenetic markers such as brain-derived neurotrophic factor DNA methylation have emerged as indirect correlates of CS-related pain phenotypes. In contrast, traditional systemic inflammatory markers show inconsistent and nonspecific associations. Conclusions: Neuroinflammatory biomarkers hold promise for mechanism-based stratification of CLBP, particularly for identifying patients with CS-driven pain. However, major methodological and translational challenges remain, including lack of standardization, limited accessibility of central nervous system-compartment measures, and the need for longitudinal and interventional validation. Future research should prioritize multi-marker and multi-compartment approaches integrated with functional phenotyping to establish clinical utility. Full article

Low back pain (LBP) remains a leading cause of disability worldwide, imposing substantial socioeconomic burdens. Among its many causes, facetogenic pain accounts for a significant proportion of cases and is generally attributed to irritation of the richly innervated facet joint capsule, mediated by the medial branches of the dorsal rami. This narrative, hypothesis-driven review synthesises the current anatomical, biomechanical, neurophysiological, and clinical literature and advances a conceptual framework proposing a novel anatomical mechanism that may contribute to LBP. We hypothesise that ossification of the mamillo-accessory ligament (MAL) may be a plausible but under-recognised anatomical variant that may influence lumbar biomechanics and neural interfaces. The MAL connects the mammillary and accessory processes of lumbar vertebrae, serving as a stabilising anchor for deep paraspinal muscles and forming a conduit for the medial branch of the dorsal ramus (MBDR). Ossification of the MAL, resulting in a mamillo-accessory foramen, may theoretically impair spinal biomechanics via three principal mechanistic domains: (1) disruption of muscle attachment and segmental stabilisation, (2) potential compression of the MBDR causing denervation and muscle atrophy, and (3) chronic nerve entrapment leading to asymmetrical postural adaptations and persistent pain. Collectively, these pathways may contribute to spinal instability, facet degeneration, and variable response to standard interventional treatments such as radiofrequency ablation. Recognition of MAL ossification may have potential implications for clinical assessment, targeted imaging strategies, and treatment stratification in patients with chronic, non-specific LBP. Full article

Background and Objectives: Chronic low back pain (CLBP) is a prevalent condition that impairs quality of life, functionality, and work productivity. While most acute episodes of back pain resolve, 4–25% become chronic due to factors such as high pain intensity, psychological distress, and maladaptive behaviors. Nonspecific CLBP is best understood through the biopsychosocial model, encompassing biological, psychological, and social influences, including kinesiophobia. Management relies on physical activity, pain education, and psychological interventions, with therapist knowledge and attitudes affecting outcomes. This study aimed to assess the prevalence of CLBP among healthcare workers, examine their knowledge of pain neurophysiology, evaluate kinesiophobia, and explore how personal experience with CLBP influences their beliefs, attitudes, and interactions with patients. Materials and Methods: A cross-sectional observational study was conducted from January to May 2025 among healthcare professionals. A total of 50 participants completed an online questionnaire, of which 42 were valid and included in the analysis. The questionnaire collected demographic and professional data, determined the presence of CLBP, and included three standardized instruments: the Revised Neurophysiology of Pain Questionnaire (rNPQ) to assess knowledge of pain mechanisms, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) to evaluate beliefs about pain and disability, and the Tampa Scale of Kinesiophobia (TSK-11) to measure fear of movement. Data were analyzed using SPSS and Microsoft Excel. Results: Among the 42 participants, 11 demonstrated low, 28 moderate, and 3 high knowledge of pain neurophysiology (rNPQ), with a mean score of 5.66. On the HC-PAIRS, the majority (30 participants) scored above 60, indicating beliefs that pain leads to disability, while 12 scored below 60, reflecting a biopsychosocial perspective; gender did not significantly affect HC-PAIRS scores (p = 0.213). As for kinesiophobia (TSK-11), 24 participants had low, 17 moderate, and 1 clinically significant fear of movement. Correlation analysis revealed that younger participants had higher rNPQ scores (r = −0.358, p = 0.020) and lower TSK-11 scores (r = −0.389, p = 0.011). TSK-11 scores increased with age (r = 0.432, p = 0.004), while HC-PAIRS scores showed no significant correlations. Conclusions: Healthcare professionals, particularly physiotherapists, show gaps in knowledge of pain neurophysiology and a tendency toward biomedical beliefs regarding chronic low back pain. This cross-sectional study indicates that a greater understanding of pain mechanisms is associated with lower kinesiophobia, emphasizing the importance of education. Integrating the biopsychosocial model into undergraduate and continuing professional training, through interdisciplinary and practical modules, may improve knowledge, reduce maladaptive fear-avoidance behaviors, and enhance patient care. Future studies should include larger, more diverse samples and assess the long-term impact of educational interventions on clinical practice. Full article

Background: Non-specific low back pain (NSLBP) is associated with altered neuromuscular control of the lumbopelvic–hip complex (LPHC). However, the functional behavior of the transversus abdominis (TrA) and gluteus medius (GM) during upright postural tasks, with and without the abdominal drawing-in maneuver (ADIM), remains unclear. This study aimed to compare TrA and GM activation between individuals with NSLBP and asymptomatic controls during standing and single-leg stance using rehabilitation ultrasound imaging (RUSI). Methods: Thirty-two participants (16 with NSLBP and 16 asymptomatic controls) underwent RUSI assessment under four task conditions: standing and single-leg stance, with and without ADIM. Muscle function was quantified using thickness change derived from ultrasound measurements. A two-way mixed-model analysis of variance with Bonferroni-adjusted post hoc comparisons was performed. Results: Significant group × condition interactions were identified for TrA activation (p < 0.05). Individuals with NSLBP demonstrated reduced TrA activation during standing with ADIM and reduced GM activation during single-leg stance compared with asymptomatic controls. The effect sizes were moderate to large for TrA activation and small to moderate for GM activation. Conclusions: These findings suggest task-specific differences in neuromuscular activation patterns in individuals with NSLBP. Ultrasound-derived thickness change measures obtained during functional, weight-bearing tasks may provide clinically relevant information to support motor control rehabilitation strategies. Full article

Background/Objectives: Low back pain (LBP) is the leading cause of disability in Saudi Arabia and contributes substantially to healthcare utilisation, reduced quality of life, and lost productivity. This guideline provides nationally standardised, evidence-based recommendations for the assessment and management of non-specific LBP and sciatica in adults, adapted to the clinical and health-system context in Saudi Arabia. Methods: A multidisciplinary Task Force developed the guideline using the GRADE ADOLOPMENT approach, using NICE guideline NG59 as the primary evidence source. One additional clinical question was formulated to address pain neuroscience education, informed by a relevant systematic review. Update literature searches were conducted in PubMed, Embase, and the Cochrane Library (2016–2022). The evidence was appraised using GRADE, and recommendations were formulated through structured Evidence-to-Decision deliberations and consensus voting. Results: The Task Force addressed eleven clinical questions in this guideline. Strong recommendations were provided for the use of validated risk assessment tools (very low certainty of evidence) and stratified management (moderate certainty of evidence). Conditional recommendations were made for indications for imaging, pharmacological treatment for sciatica, psychological interventions, multidisciplinary return to work programmes, epidural injections, prognostic value of image-concordant pathology, spinal decompression, radiofrequency denervation, and pain neuroscience education, with certainty of evidence ranging from very low to low. Conclusions: The findings indicate that management of non-specific LBP and sciatica in Saudi Arabia should be guided by clinical assessment, with restricted use of imaging, careful selection of pharmacological treatments, and appropriate use of psychological, multidisciplinary, and procedural interventions. Full article

Previous reports suggest that the progression from subacute to chronic non-specific low back pain (nsLBP) involves functional changes in both the nervous and immune systems. The purpose of the present study was to characterize the gene expression profiles of circulating immune cells that affect the interaction between these two systems when subacute nsLBP turns into chronic nsLBP. Participants aged 18–55 were included based on the presence or duration of LBP, with peripheral blood mononuclear cells collected for RNA sequencing from 20 healthy controls (no nsLBP), 20 subclinical patients (intermittent nsLBP), and 19 chronic patients (long-term nsLBP). The data revealed that chronic nsLBP is linked to a distinct gene expression profile, with 139 uniquely differentially expressed genes (DEGs), differing from those in the subclinical and control groups. Interestingly, comparing chronic and subclinical groups showed minimal overlap in DEGs, indicating a clear inflammatory distinction between subclinical nsLBP and chronic nsLBP. The findings also indicated that patients with chronic nsLBP were different from other individuals regarding axon guidance, indicating neuroplastic changes when intermittent nsLBP turns into chronic nsLBP. Hence, early recognition of the transition from subclinical to chronic nsLBP using RNA profiling may pave the way for more precise therapeutic strategies targeting neuroplastic changes and inflammatory processes. Full article

Background/Objectives: Low back pain (LBP) is the most prevalent musculoskeletal condition, significantly impacting quality of life and incurring high social costs. Although non-specific (without anatomical abnormalities) LBP accounts for nearly 80% of cases, LBP due to adult spinal deformities (ASDs), including scoliosis, remains a major concern. Several patient-reported outcome measures (PROMs)—notably the Oswestry Disability Index (ODI), Scoliosis Research Society-22 questionnaire (SRS-22), and Core Outcome Measure Instrument (COMI)—are recommended for assessment in these populations. This study aims to verify if these PROMs can effectively distinguish between adults with scoliosis-associated LBP (SLBP) and those with non-specific LBP (LBP). Methods: subjects were categorised as either having idiopathic/degenerative scoliosis (>10° Cobb angle in the coronal plane) with LBP, or non-specific LBP. Statistical comparisons applied non-parametric tests (Wilcoxon rank-sum, Mood’s median, chi-square), Spearman’s correlation, and generalised linear regression analyses. Results: Among 1092 subjects (552 SLBP; 540 LBP), median ODI scores were similar between groups, while SRS-22 scores were modestly higher in the SLBP cohort. Females consistently reported higher ODI and lower SRS-22 scores. Significant correlations arose between ODI and COMI, with moderate inverse associations with SRS-22. Regression analysis demonstrated that pathology group, gender, age, and BMI weakly predicted PROM scores. Conclusions: ODI and SRS-22 perform comparably in assessing disability in adults with LBP regardless of scoliosis, suggesting they cannot discriminate different pathologies. These findings underscore the importance of employing multiple PROMs to capture clinical dimensions. Full article

Objectives: Pilates is frequently recommended for patients with Chronic Nonspecific Low Back Pain (CNLBP) due to its potential to enhance posture, muscle strength, trunk flexibility, and stability. However, to date, there is no robust evidence supporting the effectiveness of Pilates in managing CNLBP. This study aimed to assess the effects of 8 × 8 Pilates Matwork core exercises on pain and functioning in middle-aged adult women with CNLBP, through a flexion relaxation phenomenon (FRP) analysis. Methods: We included middle adult women (n = 21) with diagnosis of CNLBP and a Numeric Rating Scale (NRS) > 4. The experimental group underwent a treatment of eight Pilates Matwork sessions, biweekly for 4 weeks, lasting about 40 min. The control group underwent standardized exercises used for managing CNLBP. Outcome measures included NRS, Oswestry Disability Index (ODI), Quebec Back Pain Disability Scale (QBPDS), and the FRP ratio via surface electromyography during trunk maximum flexion. We evaluated the participants at the baseline (T0), at the end of the 4-week treatment (T1), and at 4 weeks after the end of the treatment, at 8 weeks from the baseline (T2). Results: In this pilot RCT, 21 middle-aged adult women affected by CNLBP were randomly allocated with a ratio of 1:1 in the Pilates group, and in parallel in the control group. The experimental group showed a significant improvement in ODI and QBPDS scores compared to the control group, maintained at follow-up for ODI, along with an NRS reduction at T2. About FRP, Pilates has proven to be comparable to conventional treatment, showing no significant difference in FRR at T1 and T2. Only the experimental group exceeded the 9.5 cutoff at T2, as a protective predictive index for CNLBP. Conclusions: This pilot RCT provided preliminary evidence that Pilates might be an effective rehabilitation method, enhancing functioning and pain management in middle-aged adult women affected by CNLBP. The FRP study proves to be efficient in translating clinical assessments into rehabilitation assessment measures. Full article

Background and Objectives: Chronic low back pain (CLBP) is associated with altered neuromuscular control. Dynamic Neuromuscular Stabilization (DNS) targets core–limb coordination; however, its specific impact on lower-limb electromyographic (EMG) activity during gait remains unclear. Materials and Methods: Fifty-five young adults with non-specific CLBP (pain ≥ 3 months with no identifiable specific pathology) completed the trial (overall mean age 23.7 ± 1.3 years). Participants were randomized to an 8-week DNS program or a control. Pre-/Post-intervention surface EMG during gait and clinical outcomes (VAS, ODI) were assessed. Results: Compared with control, DNS showed lower adjusted Post-test VAS (3.08 ± 0.25 vs. 6.13 ± 0.24; ηp² = 0.596) and ODI (15.73 ± 1.55% vs. 34.36 ± 1.52%; ηp² = 0.579). Directionally, DNS was associated with phase-specific EMG modulation: tibialis anterior during mid-stance was lower (ηp² = 0.137), rectus femoris during push-off was lower (ηp² = 0.119), biceps femoris during push-off was lower (ηp² = 0.168), and vastus medialis at heel-strike was higher (ηp² = 0.077) relative to control. Other muscle–phase pairs showed no adjusted between-group differences. Conclusions: An 8-week DNS program was associated with clinically meaningful reductions in pain and disability and with phase-specific changes in lower-limb EMG during gait. These findings support DNS as a promising rehabilitation option for young adults with CLBP; confirmation in larger trials with active comparators is warranted. Full article

Background: Functional lumbar segmental instability (FLSI) is a clinically significant subtype of nonspecific low back pain, characterized by impaired motor control during mid-range spinal motion. Despite its prevalence, diagnostic approaches remain fragmented, and no single clinical test reliably captures its complexity. This scoping review aims to synthesize current evidence on the reliability, validity, subclassification, and predictive value of manual tests used in the evaluation of FLSI, and to identify conceptual and methodological gaps in the literature. Methods: A structured search was conducted across five databases (PubMed, Scopus, Web of Science, CINAHL, Embase) between May and August 2025. Twenty-four empirical studies and eleven foundational conceptual sources were included. Data were charted into five thematic domains: conceptual frameworks, diagnostic accuracy, reliability, subclassification models, and predictive value. Methodological appraisal was performed using QUADAS and QAREL tools. Results: The Passive Lumbar Extension Test (PLET) demonstrated the most consistent reliability and clinical utility. The Prone Instability Test (PIT) and Posterior Shear Test (PST) showed variable performance depending on protocol standardization. Subclassification models distinguishing functional, structural, and combined instability achieved high inter-rater agreement. Screening tools for sub-threshold lumbar instability (STLI) showed preliminary feasibility. Predictive validity of manual tests for rehabilitation outcomes was inconsistent, suggesting the need for multivariate models. Conclusions: Manual tests can support the clinical evaluation of FLSI when interpreted within structured diagnostic frameworks. Subclassification models and composite test batteries enhance diagnostic precision, but standardization and longitudinal validation remain necessary. Future research should prioritize protocol harmonization, integration of sensor-based technologies, and stratified outcome studies to guide individualized rehabilitation planning. Full article