Lumbar Manipulation (Sidelying)

Lumbar Manipulation (Sidelying Technique) Purpose: High velocity thrust maneuver used for patients who fit the TBC Manipulation criteria. Step 1: 0:50 Have the patient roll onto their side facing you near the edge of the treatment table. It does not matter which side the patient lies on, however it is important to be able to do the skill from both sides in case you have a patient who is limited to one side by pain, other injuries, etc. Step 2. 1:06 Have the patient reach their bottom arm forward. Have the patient extend their bottom leg, and flex their top hip and knee so that their top foot is hooked around the knee of the bottom leg; the top leg hangs over the edge of the table slightly. IMPORTANT: Use your own body to block the patient from rolling off the table. Step 3: 1:32 Hold the patient’s extended arm, cradle under the scapula, and , assist the patient to rotate their upper body to create lumbar rotation in the opposite direction as the pelvis. Step 4: 1:47 Have the patient cradle their head with their bottom hand, and place their top hand against their abdomen. Step 5: 2:00 Use your body to trap the patients hand against their stomach and feed your cranial hand under the patient’s arm. Your cranial arm will hold the patient’s trunk into lumbar rotation with pressure through the rib cage. Your caudal arm will pull the pelvis in the opposite rotation of the trunk until you reach a barrier. Note: Because you will be applying force with your forearms, be sure to maintain radioulnar pronation to avoid contacting the patient with the boney prominence of your ulna, as this is can be uncomfortable for the patient. Step 6: 2:36 Apply a high velocity, low amplitude thrust by using your own trunk to apply force to your caudal forearm. This occurs by gently flexing your trunk at the hips to use your body weight. **The force must produce a rotation torque. Follow lumbar manipulation with mid-range ROM exercises. Be sure to explain the technique to your patient prior to administering it. Cite the evidence in terms of safety and efficacy. Explain that the patient may experience a “pop” due to cavitation, but that it is not necessary for the technique to be successful. Patients meeting 4/5 qualifiers for the TBC manipulation group have a 95% success rate with lumbar manipulation with success defined as a 50% improvement in Oswestry score within 2 visits. Evidence: Flynn et al. Spine.2002;27:2835‐2843. Childs et al. Ann Intern Med. 2004;141:920‐928. Fritz et al. Spine J. 2006;6:289‐295. Cleland et al. Spine. 2009; 34:2720‐2729.