Chapter 8

LUMBO-PELVIC: TESTING OF LUMBAR AND LOWER THORACIC ANTERIOR-POSTERIOR GLIDE

The patient is lying on his side. His hips are flexed to about 70 degrees (90 degrees for a female), and his knees flexed more than 90 degrees. The therapist is standing, with knees and hips slightly bent, in front of the patient. The patient’s bent knees are supported between the therapist’s abdomen and the bend of his hips (for mobilization). The therapist places the tip of his index or long finger (for palpation) in the L5-SI interspinous space.


MOBILIZING FORCE:
The therapist extends his knees a few degrees to support the weight of the patient’s legs of f the table. The therapist uses his hips and abdomen to apply a horizontal force through the patient’s bent knees. This force is in line with the patient’s femur and produces a posterior glide of the lumbar vertebra. This procedure is continued superiorly (cranially) to include the T11-T12 interspinous space. Additional patient hip flexion is necessary to test the more superior segments. Hip flexion produces caudal— cranial flexion of the patient’s lumbar spine. Additional patient hip/lumbar flexion is necessary to test the more superior segments. The amount of flexion is reduced if motion occurs in a more superior segment than the one being tested.


PALPATION:
Normal mobility is detected when there is a slight posterior glide of the inferior (caudal) spinous process of the segment being tested. Hypomobility is suspected when there is reduced or absent glide of a spinous process. Hypermobility is suspected when there is excessive glide of a spinous process or when there is guarding or tenderness elicited by the patient at a segment.

* It is normal to palpate a little more AP glide at LS junction than at the other lumbar segments.

TESTING OF LUMBAR AND LOWER THORACIC ANTERIOR-POSTERIOR GLIDE

(CAUDAL-CRANIAL L5-T11)

Testing Lumbar and Lower Thorasic

Testing Lumbar and Lower Thorasic (image 2)

Testing Lumbar and Lower Thorasic (image 3)

TESTING OF LUMBAR AND LOWER THORACIC FLEXION (CAUDAL-CRANIAL L5- T11)


The patient is lying on his left side. His hips are flexed to about 70 degrees (90 degrees for a female), and his knees flexed more than 90 degrees. The therapist is standing, with knees and hips slightly bent, in front of the patient. The patient’s bent knees are supported between the therapist’s abdomen and the bend of his hips (for mobilization). The therapist places the tip of his index or long finger (for palpation) in the L5-Sl interspinous space.


MOBILIZING FORCE:

The therapist extends his knees a few degrees to support the weight of the patient’s legs of f the table. The patient’s bent knees and hips are firmly supported by the therapist as the therapist slowly moves to his right side. This movement of the therapist to his right will increase flexion of the patient’s hips and produce caudal—cranial lumbar spine flexion. The procedure is continued superiorly (cranially) to include the T11-T12 interspinous space. Additional patient hip/lumbar flexion is necessary to test the more superior segments. The amount of flexion is reduced if motion occurs in a more superior segment than the one being tested.


PALPATION:

Normal mobility is detected when there is a slight separation of the spinous processes. Hypomobility is suspected when there is reduced or absent motion at a segment. Hypermobility is suspected when there is excessive motion or guarding at a segment.

TESTING OF LUMBAR AND LOWER THORACIC FLEXION (CAUDAL—CRANIAL L5- T11)

TESTING OF LUMBAR AND LOWER THORACIC FLEXION

TESTING OF LUMBAR AND LOWER THORACIC FLEXION  (Image 2)

 

TREATMENT FOR LUMBAR AND LOWER THORACIC FLEXION (CAUDAL-CRANIAL L5- T11)

The patient is lying on his left side. His hips are flexed to about 70 degrees (90 degrees for a female), and his knees flexed more than 90 degrees. The therapist is standing, with knees and hips slightly bent, in front of the patient. The patient’s bent knees are supported between the therapist’s abdomen and the bend of his hips (for mobilization). The therapist places the tip of his right index or long finger on the spinous process of L5 (for stabilization). The tip of the therapist’s left index or long finger is at the base of the sacrum (for mobilization).


MOBILIZING FORCE:

The therapist extends his knees a few degrees to support the weight of the patient’s legs off the table. The patient’s bent knees and hips are firmly supported by the therapist as the therapist slowly moves to his right side. This movement of the therapist to his right will produce caudal-cranial flexion of the patient’s L5-SI segment. The therapist assists the mobilization force with his left fingertip to encourage separation of the L5-SI interspace. At the same time, the therapist must use his right fingertip to stabilize L5 and prevent movement of this superior vertebra.

When utilizing Grades I or II, it is not necessary to stabilize the superior spinous process.

* This procedure can be utilized for segments L5-T11. The L5-SI segment is described. Additional patient hip flexion, to include only the segment being mobilized, is necessary to mobilize the more superior segments. This is a difficult procedure to stabilize and the therapist may need to take frequent rests.

TREATMENT FOR LUMBAR AND LOWER THORACIC FLEXION (CAUDAL—CRANIAL L5- T11)

Treatment for Lumbar and lower Thoracic Flexion

Treatment for Lumbar and lower Thoracic Flexion (Image 2)

 

TESTING OF LUMBAR AND LOWER THORACIC EXTENSION (CAUDAL-CRANIAL L5- T11)

The patient is lying on his left side. His hips are flexed to about 70 degrees (90 degrees for a female), and his knees flexed more than 90 degrees. The therapist is standing, with knees and hips slightly bent, in front of the patient. The patient’s bent knees are supported between the therapist’s abdomen and the bend of his hips (for mobilization). The therapist places the tip of his index or long finger (for palpation) in the L5-SI interspinous space.


MOBILIZING FORCE
:

The therapist extends his knees a few degrees to support the weight of the patient’s legs off the table. The patient’s bent knees and hips are firmly supported by the therapist as the therapist slowly moves to his left side. This movement of the therapist to his left will reduce flexion of the patient’s hips, and produce caudal cranial lumbar extension. The procedure is continued superiorly (cranially) to include the T11-T12 segment. Additional mobilization force is necessary to test the more superior segments. The amount of hip extension is reduced if motion occurs in a more superior segment than the one being tested.


PALPATION:

Normal mobility is detected when there is a slight approximation of the spinous processes. Hypomobility is suspected when there is reduced or absent motion at a segment. Hypermobility is suspected when there is excessive motion or guarding at a segment.

TESTING OF LUMBAR AND LOWER THORACIC EXTENSION (CAUDAL-CRANIAL L5- T11)

Testing of Lumbar and Lower Thoracic Extension

Testing of Lumbar and Lower Thoracic Extension (Image 2)

 

TREATMENT FOR LUMBAR AND LOWER THORACIC EXTENSION (CAUDAL-CRANIAL L5—T11)


The patient is lying on his left side. His hips are flexed to about 70 degrees (90 degrees for a female), and his knees flexed more than 90 degrees. The therapist is standing, with knees and hips slightly bent, in front of the patient. The patient’s bent knees are supported between the therapist’s abdomen and the bend of his hips (for mobilization). The therapist places the tip of his right index or long finger on the spinous process of L5 (for stabilization). The tip of the therapist’s left index or long finger is at the base of the sacrum (for mobilization).


MOBILIZING FORCE:

The therapist extends his knees a few degrees to support the weight of the patient’s legs off the table. The patient’s bent knees and hips are firmly supported by the therapist as the therapist slowly moves to his left side. This movement of the therapist to his left will produce caudal—cranial extension of the patient’s L5—SI segment. The therapist assists the mobilization force with his left fingertip to encourage approximation of the L5—SI interspace. At the same time, the therapist must use his right fingertip to stabilize L5 and prevent movement of this superior vertebra.

When utilizing Grades I or II, it is not necessary to stabilize firmly on the superior spinous process.

When utilizing Grades III or IV, it is necessary to stabilize firmly on the superior spinous process.


* This procedure can be utilized for segments L5-T11. The L5—SI segment is described. Additional patient hip extension, to include only the segment being mobilized, is necessary to mobilize the more superior segments. This is a difficult procedure to perform and the therapist may need to take frequent rests.

TREATMENT FOR LUMBAR AND LOWER THORACIC EXTENSION (CAUDAL-CRANIAL L5—T11)

Treatment for Lumbar and Lower Throacic Extension

Treatment for Lumbar and Lower Throacic Extension (Image 2)

 

TESTING OF LOWER THORACIC AND LUMBAR ROTATION (T11 - L5)

The patient is lying on his left side with his legs extended, for testing right rotation. The therapist is standing in front of the patient, at the level of the patient’s waist. The therapist places his right forearm (for mobilization) on the patient’s upper, lateral right rib cage. The therapist’s left index fingertip (for palpation) is placed at the T11-12 interspinous space.


MOBILIZING FORCE:

A mobilization force is produced as the therapist extends his right elbow. This creates right rotation of the patient’s thoracic and lumbar spine. The mobilizing force must be forceful enough to create rotation at the T11segment. Additional mobilizing force (rotation) is necessary to produce motion in the more inferior segments as they are tested. The mobilizing force should always reduced if motion occurs in a more inferior segment than the one being tested.


PALPATION:

Normal motion is detected as gliding of the superior spinous process to the left (downward toward the table). Hypomobility is suspected when there is reduced or absent motion at a segment. Hypermobility is suspected when there is excessive motion or guarding at a segment.

* This procedure should be repeated for left rotation. The patient’s positioning and therapist’s hand placement are reversed.

TESTING OF LOWER THORACIC AND LUMBAR ROTATION (T11 - L5)

Testing of Lower Throacic Lumbar Rotation

 

TREATMENT FOR LOWER THORACIC AND LUMBAR ROTATION (T11-L5)

The patient is lying on his left side with his legs extended, for treatment of right rotation. The therapist is standing in front of the patient, at the level of the patient’s waist. The therapist places his right forearm (for mobilization) on the patient’s upper, lateral right rib cage. The tip of the therapist’s left thumb (for stabilization) is placed on the left, lateral (lower) surface of T12 spinous process.


MOBILIZING TECHNIQUE:

A mobilization force is produced as the therapist extends his right elbow. This creates right rotation of the patient’s thoracic spine. The mobilizing force must be forceful enough to create rotation at the T11 segment. The mobilizing force should always be reduced if motion occurs in a more inferior segment than the one being treated.

When utilizing Grades I or II, it is not necessary to stabilize the inferior spinous process.

When utilizing Grades III or IV, it is necessary to stabilize firmly on the inferior, lateral spinous process.


* This technique can be utilized for segments T11 - L5. The T11-T12 segment is described. Additional rotation, to include only the segment being mobilized, is necessary to mobilize the more inferior segments.

* To mobilize into left rotation, the patient should lie on his right side and the therapist’s hand positions are reversed.

TREATMENT FOR LOWER THORACIC AND LUMBAR ROTATION (T11-L5)

Testing of  Lower Throacic and Lumbar Rotation (Image 2)

 

TESTING OF LUMBAR AND LOWER THORACIC ROTATION (CAUDAL-CRANIAL L5- T11)

The patient is lying on his left side with his legs extended, for testing of right caudal-cranial rotation. The therapist is standing in front of the patient, at the level of the patient’s waist. The therapist places his left palm (for mobilization) on the patient’s right ASIS. The therapist’s right index fingertip (for palpation) is placed on the patient’s L5-SI interspinous space.


MOBILIZING FORCE:

A mobilization force is produced as the therapist extends his left elbow. This creates right caudal—cranial rotation of the patient’s lumbar spine. The mobilizing force must be forceful enough to create rotation at the L5 segment. Additional mobilizing force (rotation) is necessary to produce motion in the more superior segments as they are tested. The mobilizing force should always be reduced if motion occurs in a more superior segment than the one being tested.


PALPATION:

Normal motion is detected as gliding of the superior spinous process to the left (downward toward the table). Hypomobility is suspected when there is reduced or absent motion at a segment. Hypermobility is suspected when there is excessive motion or guarding at a segment.

* This procedure should be repeated for left caudal—cranial rotation. The patient should lie on his right side and therapist’s hand placement are reversed.

TESTING OF LUMBAR AND LOWER THORACIC ROTATION (CAUDAL-CRANIAL L5- T11)

Testing of Lumbar and Lower Throacic  Rotation (Image 3)

 

TREATMENT FOR LUMBAR AND LOWER THORACIC ROTATION (CAUDAL-CRANIAL L5—T11)

The patient is lying on his left side with his legs extended, for treatment of right caudal-cranial rotation. The therapist is standing in front of the patient, at the level of the patient’s waist. The therapist places his left palm (for mobilization) on the patient’s right ASIS. The tip of the therapist’s right thumb (for stabilization) is placed on the patient’s left, lateral (lower) surface of L5 spinous process.


MOBILIZING TECHNIQUE:

A mobilization force is produced as the therapist extends his right elbow. This creates right caudal—cranial rotation of the patient’s lumbar spine. The mobilizing force must be forceful enough to create rotation at the L5 segment. The mobilizing force should always be reduced if motion occurs in a more superior segment than the one being treated.

When utilizing Grades I or II, it is not necessary to stabilize the superior, lateral spinous process.

When utilizing Grades III or IV, it is necessary to stabilize firmly on the superior, lateral spinous process.

* This technique can be utilized for segments L5-T11. The L5- SI segment is described. Additional rotation, to include only the segment being mobilized, is necessary to mobilize the more superior segments.

* To mobilize into left caudal-cranial rotation, the patient should lie on his right side and the therapist’s hand positions are reversed.

TREATMENT FOR LUMBAR AND LOWER THORACIC ROTATION (CAUDAL-CRANIAL L5—T11)

Testing for Lumbar and  Lower Throacic Rotation

TESTING OF LUMBAR AND LOWER THORACIC SIDEBENDING (CAUDAL-CRANIAL L5—T11)


The patient is lying on his left side with his legs extended, for testing right caudal—cranial sidebending. The therapist is standing in front of the patient at the level of the patient’s hips. The therapist places a bent left elbow around the patient’s lower right buttock (for mobilization) in the area of the ischial tuberosity. The therapist’s right index fingertip (for palpation) is placed at the L5-SI interspinous space.


MOBILIZING FORCE:

The mobilizing force is produced through the therapist’s left elbow as he leans to his right to create a right caudal-cranial sidebend of the patient’s L5-SI segment. segments. The mobilization force is reduced if motion occurs in a more superior segment than the one being tested.


PALPATION:

Normal motion is detected as a glide of the inferior spinous process to the patient’s left (downward toward the table). Hypomobility is suspected when there is reduced or absent motion at a segment. Hypermobility is suspected when there is excessive motion or guarding at a segment.

* This procedure should be repeated for left sidebending. The patient should lie on his right side and the therapist’s hand placement is reversed.

TESTING OF LUMBAR AND LOWER THORACIC SIDE BENDING (CAUDAL—CRANIAL L5—T11)

Testing of Lower Throacic and Lumbar Side Bending

Testing of Lower Throacic and Lumbar Side Bending (Image 2)

 

TREATMENT FOR LUMBAR AND LOWER THORACIC SIDE BENDING (CAUDAL-CRANIAL L5—T11)


The patient is lying on his left side with his legs extended, for testing right caudal-cranial sidebending. The therapist is standing in front of the patient at the level of the patient’s hips. The therapist places a bent left elbow around the patient’s lower right buttock (for mobilization) in the area of the ischial tuberosity. The therapist’s right thumb (for stabilization) is placed on the left, lateral surface of the L5 spinous process


MOBILIZING TECHNIQUE:

The mobilization force is produced through the therapist’s left elbow as he leans to his right to create a right caudal—cranial sidebend of the patient’s L5-SI segment. The mobilizing force should always be reduced if motion occurs in a more superior segment than the one being treated.
When utilizing Grades I or II, it is not necessary to stabilize the superior spinous process.


When utilizing Grades III or IV, it is necessary to stabilize firmly on the superior, lateral spinous process.

* This technique can be utilized for segments L5—T11. The L5-SI segment is described. Additional sidebending, to include only the segment being mobilized, is necessary to mobilize the more superior segments.
* To mobilize into left sidebending, the patient should lie on his right side and the therapist’s hand placement is reversed.

TREATMENT FOR LUMBAR AND LOWER THORACIC SIDEBENDING (CAUDAL-CRANIAL L5—T11)

Treatment for Lower Throacic and Lumbar Side Bending

Treatment for Lower Throacic and Lumbar Side Bending (Image 2)

  Next: Chapter 9