Lumbar spine treatment

Question 1

What are the 5 ME treatment techniques for lumbar spine?

Answer 1

1. ME type I Neutral dysfunction long lever (NUDR)
2. ME type I neutral dysfunction seated
3. ME Type II flexed dysfunction long lever (FDDR)
4. ME type II extended dysfunction long lever (SUUE)
5. ME type II flexed or extended dysfunction seated

Question 2

What are the 3 HVLA treaments for Lumbar spine?

Answer 2

1. HVLA type I neutral dysfunction
2. HVLA type II flexion or extension dysfunction
3. HVLA supine “OB roll”

Question 3

How do you perform ME type I neutral dysfunction long lever?

NUDR (Neutral, PTP UP, pt force Down, lateral Recumbent)

Answer 3

• pt lateral recumbent PTP up and doc facing pt
• monitor at apex of curve with cephalad hand
• flex hips/knees until motion felt under monitoring hand
• lift pts ankles, SBing lumbar spine into barrier
• pt pushing ankles down toward the floor against counterforce 3-5 sec
• repeat 3 times until no further restrictions met

Question 4

How do you perform ME type I neutral dysfunction seated?

Answer 4

• pt seated with doc behind pt opposite PTP
• pt place hand on side of dysfunction on back of neck and grab elbow with other hand
• monitor at apex of curve with caudad hand
• cephalad hand passes under pts arm on nondysfunctional side to grasp arm on dysfunction side
• flex pt torso until motion felt under monitorign hand
• engage barrier by rotating and SBing pt until motion is felt under monitoring hand
• pt returns to neutral against doc counterforce 3-5 sec
• then relax and engage new RB repeat 3-5 times until no further restrictions met

Question 5

How do you perform ME type II flexed dysfunction long lever?

FDDR (Flexed, PTP Down, pt force Down, lateral Recumbent)

Answer 5

• pt lateral recumbent, PTP down, doc faces pt
• monitor with caudad hand
• grab pt bottom arm and pull anterior/superior rotating and extending into dysfunctional segment barrier
• switch monitoring hands
• caudad hand flex hips and knees until motion felt
• pt straighten bottom leg (extension barrier)
• doc may engage barrier further by increasing extension of bottom leg
• doc abduct ots top leg until motion felt (SBing)
• pt instructed to adduct leg down toward table against doc counterforce 3-5 sec and then relax
• post isometric relaxation then barrier reengaged by abducting the top leg further
• repeat 3-5 times or until no further restrictions

Question 6

How do you perform ME type II extended dysfunction long lever?
SUUE (modified SIMS, PTP UP, pt force UP, Extended dysfunction)

Answer 6

• pt modified Sims (lateral recumbant holding table), PTP up, doc facing pt
• monitor dysfunction with cephalad hand
• with caudad hand flex hips and knees through dysfunctional segment engaging flexion barrier
• pts legs dropped off table engaging SBing barrier
• pt raise both ankles Up toward the ceiling against doc counter force 3-5 sec
• relax and engage new RB by lowering legs further
• repeat 3-5 times or until no further restrictions met

Question 7

How do you perform ME type II flexed or extended dysfunction seated?

Answer 7

• pt seated doc behind opposite the PTP
• pt place hand on side of dysfunction on back of neck grasp elbow with other hand
• monitor at apex of curve with caudad hand, cephalad pass over pt arm on non-dysfunctional side to grasp arm on dysfunctional side
• place patient into flexion or extension barrier then rotate and SB
• pt return to neutral against doc counterforce 3-5 sec then relax
• repeat 3-5 times or until no further restrictions

Question 8

How do you perform HVLA for type I neutral dysfunction?

Answer 8

• lateral recumbant PTP UP doc facing pt
• monitor at apex with caudad hand
• grasp pt bottom arm and pull anterior to rotate to dysfunction and cephalad to engage SBing
• switch monitoring hands
• pt flex hips and knees until motion felt then straighten bottom leg and place top foot in popliteal space
• position cephalad arm against pt anterior shoulder
• caudad forarm contact along line between PSIS and greater trochanter
• doc induce posterior rotation at pt shoulder to dysfunctional segment while hip brought anterior to engage RB
• pt inhale deeply and at end of exhale doc exert rapid rotational thrust by rotating pt hip foward and toward the table while simultaniously moving shoulder posterior

Question 9

How do you perofrm HVLA for Type II flexision or extension dysnfunction for lumbar spine?

Answer 9

• pt lateral recumbent, PTP up and doc facing pt
• monitor seg with caudad hand and cephalad grasp pt bottom arm and pull anterior to rotate dysfunctional segment and caudad to engage SBing
• switching mointoring hands and flex hip to 90 then straighten pt bottom leg and top foot in popliteal space
• for flexion= use TORSO to engage extension barrier
• for extension= use LEGS to engage flexion barrier
• doc caudad forarm contacts posterior aspect of pt hip and cephalad arm contact pts anterior shoulder
• induce posterior rotation at pt shoulder to dysfunctional segment while the hip is brought anterior to engage the RB
• on exhale exert rapid rotation thrust through barrier by rotating pt pelvis foward and toward the table

Question 10

How do you perform HVLA supine “OB roll” for lumbar spine?

Answer 10

• pt supine fingers interlaced behind neck
• doc opposite side of PTP monitor at segment and SB trunk away until motion felt at dysfunctional seg
• place cephalad hand through pt contralateral arm and rest dorsum on sternum
• caudad hand blocks linkage at pt ASIS opposite side
• doc rotate pts trunk with cephalad hand into rotational barrier (toward doc)
• on exhale exert rotational thrust throuhg barrier with cephalad hand while stabilizing ASIS with caudad hand