It has been 22 years since this was published. We certainly know a lot more now:

Three major more subgroup mechanisms were identified:

  • Neurological Regulation
  • Immune Regulation (+/- Endocrine and Autonomic Regulation)
  • Body Imagery Pain

We also know much more about the barriers to a positive outcome (e.g., high score on NISE, Adult-Minor Neurological Dysfunction, compliance, social factors).

We also know that some people can’t learn Specific Exercises like Psoas Major. The development of the Motor Control Abilities Questionnaire and a targeted motor imagery assessment have streamlined this.

We can identify who will respond to segmental stabilization exercises:

  • good motor skill learning (biggest predictor) (Motor Control Abilities Questionnaire score)
  • articular related pain (physical assessment battery; Lumbar Spine Instability Questionnaire)
  • nociceptive related pain (Central Sensitization Screen; Motor Imagery Assessment; QST)
  • low NISE score (Neuro-Immune-Sympathetic-Endocrine Screening Questionnaire)
  • low to moderate behavioral scores (Brief Behavioral Screening Questionnaire)

With a better understand of “microinstability” and levels of certainty, we are better able to label someone as “articular related pain”.

A new test related to hip microinstability is proving to valuable in the clinic (e.g., diagnosis, outcome prediction).

We have rehabilitation options for people that have poor motor skill learning utilizing primitive reflex inhibition, postural reflex facilitation and specific sensory motor function. We have better motor priming and facilitation strategies, which can also be used when people have poor motor skill learning.

We are continually gaining insight into the complexity of the immune system and the influences of this on patient’s presentations. As well, we are gradually improving at prescribing treatments to help immune function efficiency.

Our patient education has become much more streamlined. This helps increase compliance.

Several years ago we started the project “Development of principles for the assessment and clinical use of segmental stabilization exercises”. This very important project is finally done.  There are many issues with the current literature on segmental stabilization exercises which need to be brought up in the literature (thanks to my co-authors!). I’m looking forward to publishing the related papers on this.

Although it has been a long time now, I still use specific psoas major exercises when indicated – see above (e.g., hip microinstability, SIJ loss of force closure, signs of lumbar spine instability, lumbar spine disc related pain).

Thanks to my co-authors for this.

https://www.researchgate.net/publication/262912731_Rehabilitation_of_the_stability_function_of_psoas_major