With an estimated 507,000 musculoskeletal disorders reported last year in the U.K. alone and 8.9 million working days lost throughout the same period, biomechanical prediction assessments are regularly utilised amongst physical therapists in an attempt to predict injuries in patients prior to their occurrence (‘Statistics – Work related musculoskeletal disorders’, n.d.). However, 6-9% of these reported visits are specifically related to low back pain at a cost in excess of £500 million to the NHS. Although most cases resolve within a short period of time, it is estimated 60%-80% of these patients still report symptoms a year later (Hill et al., 2008). With 85% of these episodes deemed as ‘nonspecific low back pain’ with no obvious causes, pathology or reason the dilemma of diagnosis results in challenging the central biomedical objective knowledge and measurable findings which can frustrate patients and practitioners alike (Hill et al., 2008, Lillrank, 2003).
Functional movement screens and biomechanical assessments have been developed and regularly utilised amongst physical therapists as an assessment tool in an attempt to record what Cook et al. (2014) refer to as a ‘movement competency baseline’ (Cook, Burton, Hoogenboom, & Voight, 2014). Screening methods incorporate movements such as pulling, pushing, lunging, squatting all of which are classed as signature tasks utilised in sport as well as daily living in an attempt to ‘identify deficient areas of mobility and stability in the asymptomatic active population’ (Cook et al.,2014). It is these key movements which are classed as ‘fundamental and the foundation of human movement in its entirety’ (Cook et al.,2014). However, many of these assessment and screens have been proven to be contradicting and ineffective in predicting injury and a general lack of sensitivity to numerical application observed. Dysfunctional movement patterns, muscular weakness and reduced flexibility have all been attributed as a precursor to general musculoskeletal injury (Bennett et al.,2017).
Plisky (2015) suggest that some of the misconceptions about movement screens relate to using these tools to perform something they were never intended or designed to do such as used as a holistic and comprehensive system for predicting injury, medical diagnosis or to specifically pinpoint where the problem is (Plisky, Rauh, Kaminski, & Underwood, 2006). Studies have
shown that prominent other premorbid factors such as sex, age and previous history of LBP have been seen as more comprehensive predictors of persistent disabling low back pain (Thomas et al., 1999). It is these premorbid factors that have now become popular amongst mainstream medical practitioners in the form of back pain related questionnaires such as the STarT back screening tool in an attempt to bridge the gap between subjective and objective outcomes.
One factor that musculoskeletal assessments and movement screen appear to have in common is that focus is weighted on whether an individual can or cannot achieve the required screen movement rather than how. This has resulted in an oversight by developers to arrive at a consensus on the minimum or acceptable level of muscle power, coordination, body weight, balance or flexibility required to achieve the individual screening task at hand of the screen (Sadler, Spink, Ho, De Jonge, & Chuter, 2017). Although the physical task of screening has been shown to have an economical improvement in the care of those who may suffer from acute low back pain (Mofidiet al., 2003) the individuality of each test gives us only a small insight into what is actually going on biomechanically. Many low back pain assessments have been designed in order to test specific muscular functions and postural restrictions from one another that pertain to low back pain. Further research would be needed in order to establish the overall validity and reliability of many of the commercial and popular tests being used today and whether there is and evidence to suggest there would be any benefit in combining certain elements of each such as the additional clinical tests in order to establish a comprehensive screening assessment or biomechanical test.
