lumbar mobilization

fryette's first law

- in neutral

- SBing and rotation occur to opposite sides

*if lumbar spine side bends to the right, it rotates to the left

fryette's second law

- in flexion or extension

- SBing and rotation occur to the same side

*in flexion, if the lumbar spine side bends to the right, it also rotates to the right

fryette's third law

when motion is introduced in one plane, it will decrease motion in the other two planes

when should you do combined motions?

when straight plane movements don't provocate symptoms

indication for manipulation

- no sxs distal to the knee

- recent onset of sxs (<16 days)

- low FABQ score (<19)

- hip IR ROM >35 for at least 1 hi[

combined motions - opening restriction

limitation in flexion, SBing, and rotation AWAY from the painful side

combine motions - closing restriction

limitation in extension, SBing, and rotation TOWARD the painful side

lateral stenosis will have pain with max

closing

disc herniation will have pain with max

opening

PPIVM/PAIVM mobility categorization

- normal

- excessive/hypermobile

- reduce/hypomobile

with PAIVM you're looking for

end feel!

- normal

- abnormal (spasm, soft, hard/capsular)

PPVIM/PAIVM is most reliable for

pain provocation and finding the most hypomobile segment

lumbar forward/backward bending PPVIM

- pt side-lying, with hips and knees flexed

- support pt leg with one arm and palpate between SPs with the other

- gradually flex and extend the pts trunk via the hips by shifting your weight laterally

- should feel space between SPs "opening"/"closing" as SPs separate

lumbar SBing PPVIM sidelying

- pt side-lying, hips and knees slight flexed

- IR/ER pts hips to induce passive sidebending

- compare motion betweeen segments and with contralateral motion

lumbar SBing PPVIM prone

- pt prone with pillow under stomach

- abduct pts leg to induce sidebending

(left hip abd = left SBing)

central PAIVM

- pt prone with pillow under abdomen

- use thumb or pisiform to apply pressure to target SPs

- assess end-feel, mobility, and pain

unilateral PAIVM

- pt prone with pillow under abdomen

- use thumb or pisiform to apply pressure to target TPs

- apply a gentle, anterior force toward the table

- assess end-feel, mobility, and pain

when doing unilateral PAIVM, if the patient has pain and hypomobility when pressing on L TP then what may be the problem

- closing problem on the L (extension, L SB, L ext quadrant)

- opening problem on the R (flexion, L SB, L flexion quadrant)

mobilization dosing

- initial: 2-3x per week

- session: 3-5 mob sets per restricted segment

central vs unilateral PA mobilization

- central assists with sagittal plane motion of forward and backward bending

- unilateral enhances rotation and SBing

rotation gapping

- hand closest to their head goes under their arm --> then rotate their shoulder anteriorly

- other hand rotates their pelvis until slack is taken up (then back out a little)

- thumb of hand closest to head pushes superior vertebrae up

- 2 and 3 fingers of other hand pushes inferior vertebrae down

- continue rotating torso and pelvis