An effective positioning technique for lumbar spine manipulations/mobilizations
This post is especially for the Chiro’s, Osteo’s, and manipulative PT’s…however what is discussed is just as applicable for lumbar mobilization techniques that can be applied by any manual practitioner.
In the video below I discuss a technique that I use in order to position the patient before manipulation (or mobilization) in order to ensure that the specific joint segment, or section, of interest is placed at its end-range before the thrust occurs. When using this positioning method, you will find that the amount of force needed to achieve the manipulation is FAR, FAR less than the hard body drop that is commonly used. You will also find that the amount of rotation that is needed is much less as you are able to bring a very small region to end-range without twisting/wringing out the entire spine. This becomes very important in situations of acute low back pain where range of motion is very limited due to pain. It is also important in cases where the patient is extremely flexible (in the video below I demonstrate the manipulation on a professional dancer). You will notice that very little rotation is needed…as well only a small “impulse” thrust is used.
As an aside, I am often described as an “anti-manipulative” Chiropractor as I use the modality ‘sparingly’ in my practice…although my thoughts on this topic can fill up an entire blog entry (and will be posted eventually), I will say that manipulation, like any other manual therapy modality, has a time and place….and achieves a certain goal. When that goal is indicated…then I use it as it is very effective. When it is not indicated…then I don’t. “If all you have is a hammer….everything looks like a nail”
Figure 1 - two finger contact in the interspinous spaces above and below the segment of interest
Figure 2 - the thigh is brought into flexion until you begin to feel the interspinous spaces open (fingers seperate). The higher the lumbar level, the more flexion needed.
Figure 3 - grabbing the patients arm, the upper body is rotated only until you feel the top finger move inferior to the bottom as in the picture. NO more rotation is necessary...which is not a lot.
Figure 4 - when positioned correctly the facet joint of interest is at full "end-range." Thus the amount of thrust necessary is greatly reduced
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I really enjoyed this post. Dr. Spina, as a chiroppractor, agreeing with the lit stating that what is done with the hands during a manip is of no correlation to what happens at the articular level is great. I’ve personaly heard of many DC’s brush of that literature as “wrong” haha. From what I understand, you can’t dictate where a bone will move based on the forces you provide with your hands. Bones can only move in a certain direction…e.g for the spine is has something to do with facet orientation (correct me if i’m wrong).
I look forward to reading Dr. Spiana’s take on the current state of SMT and it’s utility in everyday practice. Like him, I totally agree with its usefullness in properly classified patients (ala the CPR’s for L-spine manips).
Great post and very clear videos on the side-lying technique!
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