HVLA for Type II Extended Lumbar Joint Dysfunctions

Positioning for Lumbar Play Type Two ScriptSubject Positioning

1. Place the subject (Ashley) on her right side.

2. Ensure the rotational side is down.

Identifying L13. Use landmarks: the iliac crest marks L4.4. Count up to L1 by moving three vertebrae up: L4 to L3 to L2 to L1.5. Maintain a hand on L1 for reference throughout the process.

Understanding the DysfunctionDysfunction Type6. This is categorized as an extended dysfunction.7. Positioning during treatment must consider flexed plane dynamics.

Flexion Techniques8. Place fingers on L1 and L2.9. Use the caudad hand to grab the feet and initiate flexion until motion at L2 is felt.10. Replace hands to ensure stability; keep the integrity of position throughout.

Inducing Rotation and Positioning TechniquesRotational Movement11. Rotate the patient to the left while maintaining contact and stability at L1.12. Use caution not to lift her shoulder or lose contact during the process.

Positioning Hands13. Replace the bottom hand after initial flexion to maintain positioning on L1 and L2.14. The caudad hand needs to adjust to grab the feet again and bring them into space for continual motion.

Body Mechanics for TreatmentTherapist's Positioning15. Get the body positioned properly to facilitate movement effectively.16. Use body weight to aid in movement rather than relying solely on arms.

Depth of Movement17. Sink down and rotate the patient using body weight for better application of force.18. Ask the patient (Ashley) to indicate when more pressure is needed for efficacy.

Force ApplicationDirectional Force19. The force applied should be directed anteriorly towards the therapist and superiorly towards Ashley’s shoulder.

Breath Technique20. Encourage the patient to take deep breaths.21. After a deep breath, instruct her to exhale completely.22. Reassess the position and movement after applying treatment.