Lumbar Treatment

Question 1

Central PA (grades i-iv)

Answer 1

Pt position: prone with arms by side
PT position: standing at the side of the pt at the painful/dysfunctional segment
1. Use pisiform grip directly in the midline of the back , your head should be directly above our hands.
2. Sink until contact is made with the painful spinous process
3. Oscillate gently
Grade II
use for first assessment test
Grade III
use of second assessment
Grade I-IV for treatment

Question 2

Unilateral PA (Grade II-IV)

Answer 2

Pt position: prone with arms by side
PT position: standing to the side of the pt at the level of the painful segment
1. Locate the transverse process on the painful side of the painful vertebrae
2. Use the thumbs to apply and anterior oscillation on the transverse process
—end range should not be approached

Question 3

Physiologic Rotation

Answer 3

Pt position: sidelying with pillows under head and between knees
–painful side up, or patient comfort
–If lumbar spine is side bent, place a towel roll at the waist
PT position: standing facing the pt
–Grade I, pt rests upper hand on table with elbow flexed to limit spinal movement
–Grade II-top hand resting on own side

Question 4

Grade III Physiologic Rotation Continued

Answer 4

1. Palpate the interspaces of the painful segment with the head hand
2. Grip the pt’s top leg with the foot hand while keeping knee flexed to 90
3. Flex and extend the hip until the spinous process below the painful segment begins to move
4. Maintain this position as you lower the leg back down to the table
   - –A Pillow may be required to reduce rotation
5. Grip the pt’s iliac with both hands and perform a gentle A/P oscillation for 30 sec.
   - –The pt’s hip and shoulder should move in opposite directions

Question 5

Grade IV Physiologic Rotation

Answer 5

1. Flex hip until lower segment moves as above and lower to the table.
2. Palpate the space above the deviated segment with the foot hand; using the head hand, grip the pt’s bottom arm and pull the arm toward the ceiling to rotate the pt’s trunk until movement is felt in the interspace with the foot hand
3. Grip the upper side of the superior spinous process with the thumb of the head hand and place elbow in the anterior aspect of the pt’s shoulder
4. Grip the lower spinous process of the inferior spinous process with index and middle fingers of the foot hand and place elbow on the posterior aspect of the pelvis.
5. Rotate pt’s trunk while pushing posterior at the shoulder with the head hand while lifting the spinous process of the deviated segment and pulling anteriorly on the pelvis with the foot hand

Question 6

Transverse Pressures (Grade II-IV)

Answer 6

Pt position: Prone with arms by side
PT position: At the side of the pt at the level of painful/dysfunctional segment
Grade II:
1. Use the tip of the thumbs to contact the lateral aspect (on the side you are standing) of the appropriate spinous process
2. Lower your shoulders or raise table so that your outstretched arms near horizontal
3. Oscillate so that the pt’s buttocks rocks with the same frequency as your hands
Grade III:
–some as grade II except:
–oscillation should be out of sync with the buttock
Grade IV:
–same as grade III but smaller end range oscillations

Question 7

Longitudinal Movement (Grade I and II)

Answer 7

Pt position: Supine and relaxed
PT Position: standing at the foot of plinth
Grade I
1. Grip pt’s bilateral ankles; do not lift the legs
2. Oscillate by gently pulling inferiority on both legs
Grade II
–same as Grade I except
excursion of the pull is greater