lumbar spine techniques only

7/28/2019 Lumbar Spine Techniques Only

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Lumbar Spine

Flexion Sequence from exam to treatment (of a movement disorder): (K 185-192)Treatment if patient complains of pain with flexion and SB/rotation

Sidelying exam:

With flexion, there is Type II movement: SB and rotate same directionSo do not place a pillow under waist (rather, you can use the table

to create sidebend right if pt. is lying on left side)

Segmental gap and rotation assessment from cranial:First flex leg to hypomobile segment (determined from P/A or segmental

flexion). Flex until you feel gapping between the two spinous

processes

Rotate upper body away from PT until cranial segment moves whilestabilizing caudal segment (stop rotating before caudal segment

moves)

Apply a Grade I, II, or III rotational movement (oscillate) [Mobilization]

(stabilize caudal segment as you rotate upper body away)OR

Do isometric contractions [Contract-Relax](5 second hold and 5 second relax and continue rotation)

PT pushes upper body away and pelvis towards (pt. resists)

After you cant wind up anymore tissue, do the oppositemuscle contractions once to balance out

Segmental gap and rotation assessment from caudal:

Bottom leg is extended to facilitate pelvis rotation and top leg is flexed

Can put pillow under pelvis to induce SBRotate pelvis towards you and stabilize upper body

Treatment via mobilization or contract-relax

Extension Sequence from exam to treatment: (K 193-200)

Can also do cranial or caudal

First step is feel a hypomobile segment in segmental extensionTo progress to SB/rotation, pt. is sidelying with pillow inducing SB

With extension, there is Type I movement: SB and rotate in opposite direction

For assessment, both knees are flexed (also for flexion exam above) ?

For treatment (Cranial), top leg is in extension (pulls the pelvis caudally toreinforce lumbar SB)

For treatment (Caudal), bottom leg is extended (allows pelvis to rotate)

Treatment via mobilization or contract-relax

Other lumbar treatments: Manipulations (Grades vs Oscillations)

Only for hypomobile patients-

Sidelying exam: segmental translation: (K 180)

Most say it is only an assessment, not a treatment!!

(assesses joint play)


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Neutral spine

Flex leg to proper segment (gapping of segment)

Provide stabilization to cranial spinous processPush pt.s femur in a dorsal direction (use your pelvis to facilitate the push)

Slow weight shift to feel for tension on posterior ligaments of spine

Sidelying segmental traction: (K 183-184)Flex to hypomobile segment (K says mostly done for L5-S1)

Use two fingers to hold around spinous process of cranial segment and two

fingers for caudal segmentStabilize pelvis and upper body and then pull/rotate sacrum downward for traction

(can use forearm force for more traction)

Sidelying segmental sidebend: (K 202)Flex to hypomobile segment

With your fingers, grasp the medial aspect of the patients right paraspinals.

Place one forearm on the patients rib cage and your other forearm on the pt.sIliac crest.

Use your forearms to SB the pt.s lumbar spine toward the opposite side

(push down and out to separatethorax and pelvis), while


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lifting up the two spinous processe

Prone P/A (unilateral and central): (K 177)

For central P/A-use pisiform on spinous process orV shape fingers on each

tranverse process-Works extension

For unilateral P/A (on transverse processes)--use both thumbs back-to-back if applying P/A to side you are standing

on.

-use pisiform if applying P/A to opposite side-works rotation and SB

Ex. Left unilateral P/A- helps R rotation and L SB


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To Rule In or Out Lumbar Radiculopathy:

Sitting Traction and compression: (K 164-165)

Compression-tests for reproduction of symptoms

Push down on pt.s shoulders (have neutral spine, but can also do with

flexion and extension)

Traction-tests for alleviation of symptomsWrap your arms around pt.s rib cage, lean back, and pull upward


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Straight Leg Test (check hip flexion, DF with knee flexed, and knee extension)


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Sural, personal, and tibial nerve bias, respectively


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Prone Femoral Nerve Tension Test (check knee flexion, PF, and hip extension)

lumbar spine techniques only

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