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 direction So 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 while stabilizing 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 opposite muscle 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 SB Rotate 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 extension To 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 to reinforce 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 patientsSidelying exam: segmental translation: (K 180) Most say it is only an assessment, not a treatment!! (assesses joint play)

Neutral spine Flex leg to proper segment (gapping of segment) Provide stabilization to cranial spinous process Push 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 segment Stabilize 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.s Iliac crest. Use your forearms to SB the pt.s lumbar spine toward the opposite side (push down and out to separate thorax and pelvis), while

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

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 symptoms Wrap your arms around pt.s rib cage, lean back, and pull upward

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

Sural, personal, and tibial nerve bias, respectively

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