HVLA and lumbar review (track 2 LE)

Question 1

straight leg test for lower back pain looks for

Answer 1

nerve impingement, specifically herniated disc, of L5 (L4-L5 disc) or S1 (L5-S1) nerve roots

Question 2

what does a positive straight leg test look like?

Answer 2

reproduces pain in the back that radiates down the L5/S1 dermatome below the level of the knee between 35-70 degrees of hip flexion

Question 3

how is the straight leg test performed?

Answer 3

1. contact the patient’s ankle with your caudal hand and stabilize the opposite ASIS with your cephalad hand
2. bring the patient’s hip into flexion keeping the knee in full extension
3. the foot can also be brought into dorsiflexion to place more stress on the sciactic nerve

Question 4

lumbosacral decompression indication

Answer 4

1. release the entire lumbar spine and the lower thoracic spine in adults
2. release restrictions in sacrum for all age

Question 5

lumbosacral decompression technique

Answer 5

1. place your caudal hand under the patient’s sacrum, pointing your fingers cephalad. Heel of hand should be under the ape of the sacrum and your fingers under the base
2. place your cephalad hand perpendicular to your caudal hand under L5 with the spinous process in the middle of your palm
3. use your caudal elbow as a fulcrum to push your forearm and hand anterior and superior to disengage the ligamentous connections of the sacrum
4. add a slight inferior and anterior compression with your cephalad hand
5. find the point of equal tension in all 3 planes among the lumbosacral ligaments
6. hold this balanced position until a release is palpated

Question 6

onside lumbar HVLA considerations

Answer 6

1. avoid putting pressure directly over the greater trochanter with your caudad forearm
2. do not thrust against the shoulder with your cephalad forearm

Question 7

onside lumbar HVLA final corrective force

Answer 7

quick, anterior, superior thrust to the pelvis from your caudad forearm

Question 8

seated lumbar HVLA considerations

Answer 8

1. caution in pregnant patients

2. can place pillow between your forearm and the patient’s chest for improve comfort

Question 9

seated lumbar HVLA final corrective force

Answer 9

quick, anterior, lateral thrust to the posterior transverse process