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Questions and Answers
What is the primary reason for the greater range of motion in the lumbar spine compared to the thoracic spine?
What is the primary reason for the greater range of motion in the lumbar spine compared to the thoracic spine?
In the context of clinical application, what is a key factor in determining when to apply mobilization techniques?
In the context of clinical application, what is a key factor in determining when to apply mobilization techniques?
What characteristic of lumbar vertebrae contributes to their ability to bear heavy loads?
What characteristic of lumbar vertebrae contributes to their ability to bear heavy loads?
Which of the following best describes the role of facet joints in the lumbar spine?
Which of the following best describes the role of facet joints in the lumbar spine?
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What is the typical lumbar curve range in degrees?
What is the typical lumbar curve range in degrees?
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During lumbar flexion, which muscle initiates the movement?
During lumbar flexion, which muscle initiates the movement?
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Which ligament is primarily involved in limiting lumbar extension?
Which ligament is primarily involved in limiting lumbar extension?
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What happens to lumbar lordosis during an anterior pelvic tilt?
What happens to lumbar lordosis during an anterior pelvic tilt?
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Which motion is naturally coupled with lateral flexion in the lumbar spine?
Which motion is naturally coupled with lateral flexion in the lumbar spine?
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Which of the following muscles plays a significant role in lumbar extension after the initial movement?
Which of the following muscles plays a significant role in lumbar extension after the initial movement?
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Which statement correctly describes the role of the Iliocostalis Thoracis during full lumbar flexion?
Which statement correctly describes the role of the Iliocostalis Thoracis during full lumbar flexion?
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How does lumbar flexion impact the pelvis after 60 degrees?
How does lumbar flexion impact the pelvis after 60 degrees?
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What is the primary purpose of performing a lumbar mobility scan?
What is the primary purpose of performing a lumbar mobility scan?
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During the sitting flexion assessment, what should happen to the interspinous spaces when the patient’s torso is flexed?
During the sitting flexion assessment, what should happen to the interspinous spaces when the patient’s torso is flexed?
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What is a key component when assessing lumbar lateral flexion?
What is a key component when assessing lumbar lateral flexion?
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When performing the rotation assessment, which direction should the practitioner rotate the patient’s torso for ipsilateral rotation?
When performing the rotation assessment, which direction should the practitioner rotate the patient’s torso for ipsilateral rotation?
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In the lateral flexion assessment, the spinous processes should move ipsilaterally. What does 'ipsilateral' mean in this context?
In the lateral flexion assessment, the spinous processes should move ipsilaterally. What does 'ipsilateral' mean in this context?
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What does the practitioner need to check for during the lumbar lateral flexion by applying a force?
What does the practitioner need to check for during the lumbar lateral flexion by applying a force?
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What common mistake might affect the lateral flexion assessment positioning?
What common mistake might affect the lateral flexion assessment positioning?
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When assessing for extension restrictions in the lumbar spine, what should happen to the interspinous spaces?
When assessing for extension restrictions in the lumbar spine, what should happen to the interspinous spaces?
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What is the primary purpose of performing a lateral glide using the spinous process as a lever?
What is the primary purpose of performing a lateral glide using the spinous process as a lever?
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In which position should the patient be for the lateral glide technique?
In which position should the patient be for the lateral glide technique?
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Which hand is positioned on the medial surface of the pisiform during the lateral glide technique?
Which hand is positioned on the medial surface of the pisiform during the lateral glide technique?
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What should the clinician do to prepare the patient for a rotation glide in the side lying position?
What should the clinician do to prepare the patient for a rotation glide in the side lying position?
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What is an effect of the lateral glide technique on the lumbar spine?
What is an effect of the lateral glide technique on the lumbar spine?
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Which statement best describes the positioning of the clinician during the lateral glide technique?
Which statement best describes the positioning of the clinician during the lateral glide technique?
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What is the significance of having the lumbar spine in midrange during these techniques?
What is the significance of having the lumbar spine in midrange during these techniques?
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During the rotation glide, where should the mobilizing end of the clinician's arm be positioned in relation to the patient's trunk?
During the rotation glide, where should the mobilizing end of the clinician's arm be positioned in relation to the patient's trunk?
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What is a primary indication for using the backward bending glide mobilization technique?
What is a primary indication for using the backward bending glide mobilization technique?
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During the backward bending glide mobilization, what position is the patient required to be in?
During the backward bending glide mobilization, what position is the patient required to be in?
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What is the role of the clinician's guiding hand during backward bending glide mobilization?
What is the role of the clinician's guiding hand during backward bending glide mobilization?
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What should be the clinician's focus while maintaining the joint mobilization force during the procedure?
What should be the clinician's focus while maintaining the joint mobilization force during the procedure?
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How should the patient perform backward bending during the mobilization technique?
How should the patient perform backward bending during the mobilization technique?
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What immediate outcome should the clinician expect if the backward bending glide mobilization technique is effective?
What immediate outcome should the clinician expect if the backward bending glide mobilization technique is effective?
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How many times should the backward bending glide mobilization technique be repeated if successful?
How many times should the backward bending glide mobilization technique be repeated if successful?
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What is the primary purpose of the backward bending glide mobilization technique?
What is the primary purpose of the backward bending glide mobilization technique?
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What characteristic defines a Type 1 coupling pattern during lateral flexion?
What characteristic defines a Type 1 coupling pattern during lateral flexion?
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Which of the following best describes the coupling pattern observed in a Type 2 fixation?
Which of the following best describes the coupling pattern observed in a Type 2 fixation?
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In assessing for Type 2 fixation, which statement is accurate?
In assessing for Type 2 fixation, which statement is accurate?
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Which description correctly identifies the impact of muscular imbalances in a Type 2 fixation?
Which description correctly identifies the impact of muscular imbalances in a Type 2 fixation?
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What should be expected when assessing lateral flexion with no movement in Type 3 fixations?
What should be expected when assessing lateral flexion with no movement in Type 3 fixations?
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Which approach is critical for improving kinetic chain function?
Which approach is critical for improving kinetic chain function?
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During a lateral flexion assessment, which of the following actions is appropriate?
During a lateral flexion assessment, which of the following actions is appropriate?
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What should clinicians focus on during the assessment phase for lateral flexion?
What should clinicians focus on during the assessment phase for lateral flexion?
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What condition is characterized by abnormal lateral flexion combined with abnormal rotation in the lumbar spine?
What condition is characterized by abnormal lateral flexion combined with abnormal rotation in the lumbar spine?
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During the lumbar sitting flexion assessment, which change indicates a restriction in flexion?
During the lumbar sitting flexion assessment, which change indicates a restriction in flexion?
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In the context of muscular imbalance related to type 4 assessments, what is true about the Multifidus muscles?
In the context of muscular imbalance related to type 4 assessments, what is true about the Multifidus muscles?
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Which of the following assessments must be completed in order to diagnose type 4?
Which of the following assessments must be completed in order to diagnose type 4?
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What position should the patient be in during the sitting lateral flexion assessment?
What position should the patient be in during the sitting lateral flexion assessment?
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What abnormal assessment finding occurs during contralateral rotational assessment related to type 4?
What abnormal assessment finding occurs during contralateral rotational assessment related to type 4?
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During the lumbar mobility scan, what indicates normal lateral flexion movement in relation to the spinous processes?
During the lumbar mobility scan, what indicates normal lateral flexion movement in relation to the spinous processes?
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What is one key aspect that differentiates a type 3 fixation from a type 4 fixation?
What is one key aspect that differentiates a type 3 fixation from a type 4 fixation?
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What is a specific indication for performing the spinous push technique?
What is a specific indication for performing the spinous push technique?
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During a lateral flexion assessment, if the spinous process moves away from the testing side, what does this indicate?
During a lateral flexion assessment, if the spinous process moves away from the testing side, what does this indicate?
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Which positioning is correct for the practitioner when performing a lumbar spinous hook?
Which positioning is correct for the practitioner when performing a lumbar spinous hook?
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What modification should be made to the traction technique if the patient has spondylolisthesis?
What modification should be made to the traction technique if the patient has spondylolisthesis?
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In the context of disc closure techniques, which assessment finding indicates a fixed lateral flexion?
In the context of disc closure techniques, which assessment finding indicates a fixed lateral flexion?
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What is the primary goal of the thrust applied during a lumbar spinous push?
What is the primary goal of the thrust applied during a lumbar spinous push?
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Which structure is specifically targeted when performing a lumbar traction technique?
Which structure is specifically targeted when performing a lumbar traction technique?
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What kind of muscular imbalance is indicated by a lateral flexion that results in the SP moving toward the testing side?
What kind of muscular imbalance is indicated by a lateral flexion that results in the SP moving toward the testing side?
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What is the appropriate line of drive when performing a lumbar spinous hook?
What is the appropriate line of drive when performing a lumbar spinous hook?
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When should the indifferent hand be positioned during the lumbar spine techniques?
When should the indifferent hand be positioned during the lumbar spine techniques?
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Which contraindication applies to all the described lumbar mobility techniques?
Which contraindication applies to all the described lumbar mobility techniques?
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What is the primary purpose of lumbar joint slack removal during these techniques?
What is the primary purpose of lumbar joint slack removal during these techniques?
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When assessing the lumbar spine's rotational movement, which observation indicates a normal response?
When assessing the lumbar spine's rotational movement, which observation indicates a normal response?
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Which technique is recommended for addressing faulty mechanics pertaining to the quadratus lumborum (QL)?
Which technique is recommended for addressing faulty mechanics pertaining to the quadratus lumborum (QL)?
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Study Notes
Lumbar Spine Anatomy and Biomechanics
- The lumbar spine has more motion than the thoracic spine due to the absence of ribs.
- The lumbar spine bears significant loads from body weight, lifting, and other movements.
- The lumbar spine's movement is dictated by facet joints, which are aligned differently in the upper and lower regions, leading to varying degrees of flexion and extension.
- The typical lumbar vertebrae are wide from side to side.
- L5 is atypical due to its larger size, shorter transverse processes, and different facet orientation.
- The lumbar curve should be 40-60 degrees.
- Anterior pelvic tilt increases lumbar lordosis, placing more stress on facets.
- Posterior pelvic tilt decreases lumbar lordosis, placing stress on intervertebral discs.
Lumbar Spine Movements and Muscles
- Flexion: Initiated by concentric contraction of the Psoas and abdominals, controlled by eccentric contraction of the erector spinae.
- Extension: Initiated by concentric contraction of the sacrospinalis, controlled by eccentric contraction of the abdominals and gravity.
Lumbar Mobilization Techniques
Lateral Glide
- Purpose: Assess for lumbar spine joint impairment, increase accessory motion, increase range of motion, decrease pain.
- Positioning: Patient prone with lumbar in midrange, clinician at the patient's side, stabilizing hand on the inferior spinous process, mobilizing hand on the superior spinous process.
- Procedure: Stabilize the inferior vertebra, glide the superior spinous process towards the contralateral side during exhalation.
Rotation Glide (Side Lying)
- Purpose: Increase accessory motion into lumbar vertebral body rotation, increase range of motion, decrease pain.
- Positioning: Patient side lying on the untreated side, clinician at the side facing the anterior trunk, inferior vertebrae locked by bringing the patient's knees towards their chest.
- Procedure: Continuously adjust the position to maintain the mobilization force, ensure the technique does not reproduce the patient's pain.
Backward Bending Glide
- Purpose: Increase pain-free range of motion into backward bending.
- Positioning: Patient prone, clinician at the side, mobilizing hand on the spinous process, guiding hand on anterior inferior ribs.
- Procedure: Apply a superior glide to the vertebra, instruct the patient to perform a backward bend while maintaining the glide, apply overpressure at the end of the range.
General Notes on Mobilization Techniques
- These techniques are only indicated if they can be performed without increasing the patient's pain.
- They should result in an immediate increase in range of motion and/or decrease in pain.
- If effective, the techniques should be repeated 2-3 times.
Understanding Problematic Segmental Coupled Lateral Flexion/Rotation Fixation Types
-
Type 1 (Normal Coupling Pattern)
- Lateral Flexion is coupled with Axial Rotation to the OPPOSITE side (Contralateral)
- Posterior body rotation occurs towards the contralateral side of Lateral Flexion
- Spinous Process (SP) rotates towards the ipsilateral side of Lateral Flexion
- Apply a lateral to medial force on SP to test mobility
- Normal motor control is achieved through ECCENTRIC unilateral contraction of the contralateral Quadratus Lumborum muscle
Type 2 (Abnormal Coupling Pattern) - Rotary Type Fixation
- Lateral Flexion is coupled with ABNORMAL Axial Rotation to the SAME side (Ipsilateral)
- Posterior body rotation occurs towards the Ipsilateral (same) side of Lateral Flexion
- SP rotates AWAY to the contralateral side of testing
- Lateral Flexion assessment is ABNORMAL but Rotational assessment is NORMAL
- Muscular imbalance of the Contralateral Sacrospinalis (especially Longissimus and Spinalis portions) exists.
- Lesion is contralateral to testing side
Type 3 (Diverging from Normal Coupling Pattern)
- Lateral Flexion is associated with either NO movement or movement in the direction opposite to trunk bending
- SP rotates normally towards the ipsilateral side of Lateral Flexion (Testing Side)
- Apply a lateral to medial force on SP to test mobility.
- Upper hand traction is applied superiorly
- Contact hand pushes into the mamillary process towards the practitioner
- Body weight is dropped down onto the thigh slowly
- Body weight is dropped once traction has reached end stage
-
Contraindications:
- Spondylolisthesis
- Acute lumbar disc lesion (herniation)
Type 4 (Abnormal Lateral Flexion combined with Abnormal Rotation)
- Lateral Flexion is associated with abnormal coupled rotational movement
- During Lateral Flexion, the SP moves to the contralateral side (OPPOSITE) of testing thumb (Abnormal)
- A dysfunctional pattern exists where a proper rotational assessment needs to be done on the contralateral side of lateral flexion to see if the SP moves into the “new” testing contact during rotation.
- Both Lateral Flexion and contralateral Rotational assessments must be ABNORMAL
- Muscular imbalance of the contralateral Multifidus Muscles exists
- Lesion is contralateral to testing side of Lateral Flexion and Ipsilateral side of Rotation Assessment
Lumbar Spinous Hook
-
Indications:
- Superior fibers of the Sacrospinalis muscle L1-L5 in spasm
- Coupled Rotary type fixation
- Posterior rotation mal-fixation (Type II fixation) from L1-L5
- Can also be done on T11-T12
-
Assessment:
- Lumbar Assessment (Rotation and Lateral Flexion)
- Lateral Flexion - SP moves away from testing side (Abnormal)
- Rotation - SP moves away from testing side (Normal)
- Lumbar Assessment (Rotation and Lateral Flexion)
-
Patient Position:
- Side posture (Lesion side DOWN)
- Head piece elevated or pillow used to elevate head
- Lower arm is pulled and folded over the top shoulder, stabilized with the indifferent hand and provide traction superiorly
- Lower leg is slightly bent at the knee
- Upper leg is flexed with upper foot place in the popliteal space (behind knee of lower leg) to provide rotational traction
- Pelvis must remain at 90 degrees to the table
-
Practitioner Position:
- Fencer (lunge stance)
- Pelvis is level with the affected spinal segment
- Bent upper leg of the patient is placed between the Practitioner’s thighs
- Practitioner performs a thigh to knee contact with patient
- Practitioner’s torso should not rotate and spine should be straight
-
Contact Point:
- Contact Hand:
- Middle finger on the contralateral side of the involved spinous process
- Hand and forearm rest on the superior ileum of the patient
- Practitioner’s elbow is kept close to the torso
- Indifferent Hand:
- On superior shoulder holding patient’s lower arm and providing superior traction while holding them in posterior rotation
- Contact Hand:
-
Joint Slack:
- Remove joint slack by pressing against the SP with the contact hand and adding enough hip flexion and upper body traction/rotation
-
Line of Drive:
- Medial to Lateral
-
Thrust:
- Leg and body drop on the patient while the contact hand hooks the SP from medial to lateral
-
Contraindications:
- Spondylolisthesis
- Acute lumbar disc lesion (herniation)
Disc Closure
-
Indications:
- Disc closure issue, faulty mechanics, or overactive QL
- Type 3 fixation from L1-L5
- Can also be done on T10-T12
-
Assessment:
- Lumbar Assessment (Lateral Flexion)
- Lateral Flexion - SP moves into testing side but is challenged and remains fixed (Abnormal)
- Lumbar Assessment (Lateral Flexion)
-
Patient Position:
- Side posture (Lesion side DOWN)
- Side lying (lesion open disc wedge side up) with NO torso rotation
- Maximal elevation of the head and knee pieces of the table
- Arms folded on chest or shoulders and stabilized by indifferent hand
-
Practitioner Position:
- Fencer (lunge) stance
- Pelvis is level with the lesion on the patient
- Lower leg slightly bent at the knee
- Upper leg flexed with upper foot place in the popliteal space (behind knee of lower leg) to provide rotational traction
- Locate the lesion and monitor interspinous movement above and below the lesion while flexing the patient’s leg
- Practitioner’s torso should not rotate and spine should be straight
-
Contact Point:
- Contact Hand:
- Reinforced second finger in the interspinous space
- Forearm wraps around the pelvis and is resting on patient’s ileum
- Indifferent Hand:
- Forearm and hand are placed over the patients shoulder
- Contact Hand:
-
Joint Slack:
- Remove joint slack with contact hand by pressing in against the interspinous space and adding enough hip flexion and upper body traction
-
Line of Drive:
- Forearm contacts accentuate a C curve in the patient’s spine
- Line of drive is directly downward on to the lesion site
-
Thrust:
- Inferior to produce a closure of the non-functioning disc space
-
Contraindications:
- Spondylolisthesis and Acute lumbar disc lesion (herniation)
Spinous Push
-
Indications:
- Superior fibers of the sacrospinalis muscle L1-L5 in spasm
- Rotational Fixation (Type 4 fixation) from L1-L5 (Type IV Push to help remember)
- Can also be done on T11-T12
-
Assessment:
- Lumbar Assessment (Rotation and Lateral Flexion)
- Lateral Flexion - SP moves away from testing side (Abnormal)
- Rotation - SP moves toward testing side (Abnormal)
- Lumbar Assessment (Rotation and Lateral Flexion)
-
Patient Position:
- Side posture (Lesion side UP)
- Side lying with minimal torso rotation
- Maintain spine and pelvis at 90 degrees to the table
- Pull on the lower arm and fold over the top shoulder stabilizing with the indifferent hand and provide traction superiorly
- Lower leg slightly bent at the knee
- Upper leg flexed with upper foot place in the popliteal space (behind knee of lower leg) done to provide rotational traction
- Pelvis must remain at 90 degrees to the table
-
Practitioner Position:
- Fencer (lunge stance)
- Pelvis is level with the affected spinal segment
- Bent upper leg of the patient between the Practitioner’s thighs
- Practitioner performs a thigh to knee contact with patient
- Practitioner’s torso should not rotate and spine should be straight
-
Contact Point:
- Contact Hand:
- Forearm resting on patient’s ileum and gluteal muscles pulling ileum towards the practitioner
- Fully flex and ulnar deviate wrist with Index and Middle Finger contact against affected SP with a fully enforced arch (L1-3)
- OR
- Fully flex the wrist with Index and Middle Finger or Middle Finger and Ring Finger contact against affected SP with a fully enforced arch (L4-5)
- Indifferent Hand:
- On superior shoulder holding patient’s lower arm and providing superior traction
- Contact Hand:
-
Joint Slack:
- Remove joint slack with contact hand by pressing against the SP and adding enough hip flexion and upper body traction
-
Line of Drive:
- (L1-L3) Inferior to Superior (45 Degree angle)
- (L4-L5) Lateral to Medial (Perpendicular to table)
-
Thrust:
- Leg and body drop on the patient while the contact hand is on the affected SP:
- L1-L3 Thrust: Thrust is inferior to superior (45 degree angle) on the spinous process
- L4-L5 Thrust: Thrust is perpendicular to the spinous process
- Leg and body drop on the patient while the contact hand is on the affected SP:
-
Contraindications:
- Spondylolisthesis and Acute lumbar disc lesion (herniation)
Hand Positioning
- If the SP doesn’t move or is stiff, this is a Type 3 fixation
- Type 3 fixations are rare and manipulation techniques for them are not covered.
- Type 3 fixations are theorized to result from faulty disc mechanics/closure or over dominance of the QL.
Lumbar Mobility Scan: Sitting
-
Flexion/Extension Assessment:
- Patient is sitting with arms crossed (bear hug)
- Practitioner sits or stands behind the patient
- Place the non-palpating forearm across top of the patients posterior shoulder
- To test for flexion restrictions, place 3 fingers into the interspinous spaces and passively flex the patient’s torso forward, the spaces should open up (GAP increases).
- To test for extension restrictions, place 3 fingers into the interspinous spaces and passively extend the patient’s torso backwards, the spaces should close (GAP decreases).
-
Lateral Flexion Assessment:
- Patient is sitting UPRIGHT (no slouching) with arms crossed (bear hug)
- Practitioner sits or stands behind the patient
- Contact patient’s ipsilateral shoulder with forearm
- Place your thumb (contact) on the lateral surface of the SP’s on the side of INDUCED lateral flexion (Ipsilateral side)
- Take the patient’s torso and Laterally Flex them Ipsilateral (towards your testing side)
- The SP should move Ipsilateral (Into testing side)
- “Lumbar Lateral Flexion Loves you”
- Now challenge.
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Description
Explore the complex anatomy and biomechanics of the lumbar spine in this quiz. Understand its unique movements, load-bearing capabilities, and the role of various muscles in flexion and extension. Perfect for students and professionals in the medical and physical therapy fields.
