University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Forward Bending Single Leg

Patient Position: The patient is positioned side lying with the lower leg bent for support. The upper leg is flexed at the hip and knee, and rests on the operators upper thigh region. Therapist Position: The therapist faces the patient and positions himself/herself at the patients abdominal level. Use a broad base of support, and positon yourself parallel to the table. Stabilizing / Mobilizing Hand: The therapist stabilizes the undersurface of the lower leg. Thigh rests on the patients shin/knee. Palpating Hand: The therapist utilizes the other hand to palpate the interspinous space at the motion segment tested. Use your forearm to offer support and to control the trunk against rotation. Segmental Test: The therapist rocks the patients leg forward until separation of the spinous process is felt. The therapist tests for the velocity of separation between the segments, the resistance of the soft tissue to movement, and the amount of separation of the segment.

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Forward Bending Double Leg

Patient Position: The patient is positioned side lying with both legs flexed, and resting on the examiners upper thigh. Therapist Position: The therapist faces the patient and positions himself / herself at the patients abdominal level. Use a broad base of support and position parallel to the table. Stabilizing / Mobilizing Hand: The therapist supports the undersurface of the bottom leg with one hand. Palpating Hand: The therapist palpates the interspinous space of the segment being tested. Segmental Test: The therapist rocks the patients legs forward until separation of the spinous process is felt at the motion segment. The therapist notes the velocity of separation of the spinous processes, resistance to separation by the soft tissue, and the amount of separation at the motion segment.

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Side Bending Double Leg

Patient Position: The patient is positioned side lying with the hips and knees bent to a 90 angle. The knees rest on the therapists upper thigh region. Therapist Position: The therapist faces the patient, and is positioned at the patients hip level. Stabilizing / Mobilizing Hand: The therapist supports the undersurface of the patients lower leg with one hand. Palpating Hand: The therapist palpates the interspinous space on the convex side of where motion will occur with the free hand. Segmental Testing: The therapist lifts the legs upward producing side bending to the side of the patient which is closest to the ceiling. Lowering the legs produces side bending to the opposite direction, or to the side in which the patient is lying. In the above example, the patient is in left side lying, lifting the legs upwards produces a right side bending test. Lowering the legs produces a left side bending test. This particular method is good when the patients legs are petite.

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Side Bending Pelvic Rock

Patient Position: Patient is side lying with hips and knees supported on the plinth at 90 of flexion. Therapist Position: Standing facing towards the patients feet. Mobilizing Hand: Left hand on the greater trochanter. Palpating Hand: Right hand on the back with the middle finger palpating between the spinous processes on the top side. Segmental Testing: The pelvis is gently pushed away to create side bending to the opposite side. To side bend the patient in the other direction the hand and forearm are turned and the pressure on the trochanter reversed in a cephalic direction.

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Side Bending - Hip Abduction Knee Flexion

Patient Position: The patient is prone with a pillow under the abdomen to remove the lordosis. Therapist Position: Standing facing the patient. Stabilizing / Mobilizing Hand: Caudal hand reaches over the extended knee and grasps the thigh just above the knee then raises the leg just slightly off the table. Palpating Hand: Cephalic hand rests on the patient with the thumb on the near side of the more cephalic spinous processes. Segmental Test: The leg is abducted and the side bending motion is felt. Note: If the patient has a tight rectus femoris causing excessive lordosis with this technique choose the similar technique with the knee in full extension (on the following page).

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Side Bending - Hip Abduction Knee Extension

* This method is chosen over the Lumbar Side Bending - Hip Abduction Knee Flexion method when the patient demonstrates a tight rectus femoris causing excessive lumbar lordosis and thus limiting the side bending motion. Clinically, the method with knee flexion is physically easier for the operator. Patient Position: The patient is prone with a pillow under the abdomen to remove the lordosis. Therapist Position: Standing facing the patient. Stabilizing / Mobilizing Hand: Caudal hand reaches over the extended knee and grasps the thigh just above the knee then raises the leg just slightly off the table. Palpating Hand: Cephalic hand rests on the patient with the thumb on the near side of the more cephalic spinous processes. Segmental Test: The leg is abducted and the side bending motion is felt.

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Rotation Prone Lying Raising Pelvis

Patient Position: Prone lying with adequate pillow support to eliminate some of the lordosis. Therapist Position: The therapist faces the patient at the abdominal level. Mobilizing Hand: Place hand under the ASIS Palpating Hand: The free hand of the therapist will rest flat on the patients back with the thumb palpating between the spinous process. Grade the movement of the more caudal spinous process relative to the cephalic process. Segmental Test: The therapist lifts and rotates the pelvis, raising the patients hip in a rotary manner to produce rotation .

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Rotation Prone Lying Rolling Legs

Patient Position: Prone lying with an adequate pillow to offset the lordosis. The knees should be bent from 70 - 90. Therapist Position: Stand facing the patient at the level of the patients hips. Stabilizing / Mobilizing Hand: Grasp the patients ankles and roll them away until the motion can be felt. Palpating Hand: Hand flat on back with thumb between the spinous processes on the far side. The therapist feels for motion of the caudal spinous process on the cephalic spinous process. The caudal process will move to the side in which the legs are being rotated. Segmental Testing: The rotation tested will be to the same side where the legs are rotated. The thumb can then be placed on the other side to assess rotation in the other direction.

University of Delaware Physical Therapy Advanced Orthopedics

Lumbar Rotation Prone Lying Impulse Over TP

Patient Position: Prone lying over an adequate pillow to negate excessive lordosis. Therapist Position: Stand facing the patient. Mobilizing Hand: To create right rotation, the right hand with the thumb facing down the back, is rested on the patient with the ulnar border just distal to the pisiform positioned over the transverse process. Palpating Hand: Same hand Segmental Testing: The therapist unweighs his body into the arm that is in contact with the transverse process. Once the soft tissue slack is taken up, a P/A spring is applied into the transverse process. Do not recoil force arm. The vertebrae rotates to the contralateral side of the induced motion. The force arm should be directed towards the umbilicus. This test can be used to assess motion from L2/L3 to L5/S1.

University of Delaware Physical Therapy Advanced Orthopedics

Mid Thoracic Prone Lying Spring Test Via Spinous Process

Patient Position: Prone lying with adequate pillow under the thoracic spine. Therapist Position: Stand facing the patient. Mobilizing Hand: Right hand resting on patient with the thumb facing down the back. The contact is with the hollow just distal to the pisiform which is placed on the tip of the spinous process. Palpating Hand: Same hand Segmental Test: The forearm is placed directly above the spine and at a right angle to the convexity of the patients thoracic spine. The hand, in time with breathing, takes up the slack during exhalation and applies a modest degree of pressure. When the patient has exhaled half way a short sharp impulse is applied to the patients spinous process. Do not recoil the force arm.

University of Delaware Physical Therapy Advanced Orthopedics

Thoracic Spine Prone Lying Spring Test T.P.s PA Glide

Patient Position: Prone lying with adequate pillow under the thoracic spine. Therapist Position: Stand facing the patient. Mobilizing Hand: Distal Phalange of 2nd and 3rd digit are placed over the transverse process. Forearm rests down on patient. Ulnar border of the fifth metacarpal of the other extremity rests across the two distal phalanges. Segmental Test: As in the above example, the force arm is perpendicular to the thoracic spine. Take up the slack as the patient exhales and at the mid-range point a small sharp impulse is delivered equally through the two finger contacts to create the PA glide. Do not recoil the force arm.

University of Delaware Physical Therapy Advanced Orthopedics

Thoracic Spine Prone Lying PA Glide - Rotation

Patient Position: Prone lying with adequate pillow under the thoracic spine. Therapist Position: Stand facing the patient. Mobilizing Hand: Distal Phalange of 2nd and 3rd digit are placed over the transverse process slightly staggered so that the TP of two adjacent vertebra are now contacted. Forearm rests down on patient. Ulnar border of the fifth metacarpal of the other extremity rests across the two distal phalanges. Segmental Test: As in the above example, the force arm is perpendicular to the thoracic spine. Take up the slack as the patient exhales and at the mid-range point a small sharp impulse is delivered equally through the two finger contacts to create the PA glide. Note: Rotation will occur to the side of the lowest finger.

University of Delaware Physical Therapy Advanced Orthopedics

Upper Thoracic Long Axis Extension with Backward Bending

Patient Position: Patient sitting on stool or edge of chair with feet on floor and wide base of support. Ask patient to fold arms. Therapist Position: Stand facing the patient with a staggered step. One foot in between two feet of patient. Mobilizing Hand: Fish both arms through folded arms of patient with hands placed on spine as in picture above finger tips to contact under the TP of vertebra. Use thumbs to block excessive cervical backward bending. Palpating Hand: Same as mobilizing hand. Segmental Test: Bend patient at the waist and then lift patient up into backward bending, using your legs to do all the work. A majority of the patients weight will shift to their feet make sure their feet are positioned with a wide base of support and slightly out in front of them. This is a good general mobilization technique for upper and mid thoracic spine. Helpful to offset excessive kyphosis. Often a good technique for elderly patients. Not appropriate for patients with a retrokyphosis and or shoulder dysfunction.

University of Delaware Physical Therapy Advanced Orthopedics

Mid Lumber Spine Rotation in Side Lying

Ligamentous Tension Locking Facet Distraction Patient Position: Side lying, facing the operator. Therapist Position: Stand facing the patient close to table Step One: Use Single leg forward bending technique to identify restriction in the lumbar spine. Forward bend to the involved level, stop and rest the patients leg on the table. Change hand palpating the interspace. Step Two: Grab patients arm above the elbow and facilitate rotation until it is identified at the involved level noted above. Step Three: Shift weight and thread cephalic extremity through the axilla of the patient. The caudal forearm rests on the hip of the patient. Mobilizing finger of cephalic hand should be on the top side of the spinous process. The mobilizing finger of the caudal hand should be on the bottom side of the adjacent spinous process. Step Four: The patient is instructed to take a deep breath and then to breath out. As the patient exhales, take up the slack through all the contact points encouraging a rotation. During the second exhalation move a little further, taking up more slack. Note: Keeping the patients top knee straight (rather than flexed) helps to facilitate a mobilization at L5/S1. Refer to demonstration in class. Several pictures on the following page should help to describe the above.

University of Delaware Physical Therapy Advanced Orthopedics

Mid Lumber Spine Rotation in Side Lying

Ligamentous Tension Locking Facet Distraction

Step One

Step Two

Step Four