Lumbar Treatment

Question 1

Type Two Mechanics

Answer 1

Flexion/extension component
Often single vertebra
Sidebending and rotation go to same side

Question 2

ME Type I Neutral Dysfunction Long Lever

Answer 2

NUDR
“Neutral dysfunction, PTP up, Pt’s force down, lateral recumbent”

Patient lateral recumbent w/ PTP up
Doc facing patient
Monitor at apex with cephalad hand
Flex hips and knees 90 degrees
Rotate top shoulder posteriorly
Lift ankles - sidebending lumbar spine into barrier
Patient pushes feet/ankles towards floor against doc counter force
Hold 3-5 secs
Relax (post-isometric relaxation)

Question 3

ME Type I Neutral Dysfuction Seated

Answer 3

Patient seated doc standing behind opposite PTP
Patient's hand on side of PTP grasp neck
Other hand grasp contralateral elbow
Monitor at apex of group curve
Pass under opposite axillary and grasp bicep on side of PTP
Engage barriers
Patient tries to return to neutral
Hold for 3-5 secs
Relax

Question 4

ME Type II Flexed Dysfunction Long Lever

Answer 4

FDDR
“Flexed dysfunction, PTP down, Pt’s force down, lateral recumbent”

Patient lateral recumbent w/ PTP down
Doc facing patient
Monitor at dysfunction
Flex hips and knees 90 degrees
Patient straightens lower leg
Lower leg extended further
Doc grasp ankle and abduct upper leg
Patient adducts down
Hold for 3-5 secs
Relax

Question 5

ME Type II Extended Dysfunction Long Lever

Answer 5

SUUE
“Modified sims position, PTP up, Pt’s force up, extension dysfunction”

Patient in modified sims position with PTP up
Doc facing patient
Monitor dysfunction
Flex hips and knees through segment
Engage flexion barrier
Pt’s legs dropped off table - engage sidebending barrier
Pt’s raise ankles up against doc’s counterforce
Hold 3-5 secs
Relax

Question 6

ME Type II Flexed or Extended Dysfunction Seated

Answer 6

Patient seated
Doc behind opposite side of PTP
Pt hand on side of dysfunction grasp neck
Other hand grasp contralateral elbow
Monitor at dysfunctional segment
Go over both arms to grasp bicep
Flex/extend
Rotational/sidebending barriers
Patient tries to return to neutral position
Hold 3-5 secs
Relax

Question 7

HVLA Type I Neutral Dysfunction

Answer 7

Patient lateral recumbent w/ PTP up
Doc facing patient
Monitor at apex of group curve
Grasp lower arm and pull anterior and cephalad
Flex hips and knees to 90 degrees
Patient straightens lower leg and places top foot in popliteal space
Doc places cephalad arm against Pt’s anterior shoulder, caudal arm against posterior aspect of hip
Posterior rotation to shoulder, anterior rotation to hip
End of exhalation -> rapid rotational thrust forward and towards table at pelvis

Question 8

HVLA Type II Flexion of Extention Dysfunction

Answer 8

Patient lateral recumbent w/ PTP up
Monitor at segment
Grasp lower arm and pull anterior and caudad
Flex hips 90 degrees
Straighten lower leg, hook foot in popliteal fossa
Cephalad arm over shoulder, caudad arm over posterior aspect of hip
Posterior force on shoulder, anterior force at hip
End of exhalation -> rapid rotational thrust forward towards table at pelvis

Question 9

HVLA Supine “OB Roll”

Answer 9

Patient supine, fingers interlaced behind neck
Stand opposite PTP
Monitor at segment
Sidebend trunk away from doc
Cephalad hand through patients arm, rest dorsal aspect of hand on manubrium of sternum
Caudad hand at ASIS on side of dysfunction
Rotate trunk into barrier (toward doc)
End of exhalation -> rotational thrust through barrier w/ cephalad hand

Question 10

Type One Mechanics

Answer 10

TONGO

Type One Neutral Group sidebending and rotation go Opposite