This manipulation can be very helpful to reduce an internal derangement in the lumbar spine.
Of course, manipulation is not always the treatment of choice. So, we have to focus on important clinical elements from the inspection, the history and the functional examination to determine if manipulation could be useful in this particular sub-group of patients. Careful patient selection is an absolute priority.
Keep in mind at all times the specific indications and contraindications, as well as the outlined manipulative strategy which is part of the lumbar spine course.
Most manipulation techniques in the lumbar spine are technically not so difficult to perform, but they can only be successful we respect the selection criteria. That's the difficulty: how can I know if this patient is suitable for manipulation or not? The answer lies in objective clinical reasoning and a correct interpretation of the clinical image. You know what the best way is to manage this fascinating knowledge? Join the Mastermind private training in orthopaedic medicine.
Sarting position : the couch is as low as possible.
The patient lies initially on the painfree side, with the arm behind the back.
Execution : again, the slack is taken up in rotation ; both rotations should be equal. The therapist uses one hand, fingers upwards, against the anterior superior spine of the ilium to obtain pelvic rotation, and maintains it by extending his elbow.
With the other hand against the spine of the scapula, he builds in shoulder rotation. The second element is the distraction : the therapist faces the patient’s head, rises on tiptoe and uses his body weight above the patient in a longitudinal direction.
The manipulative thrust is a downward jerk towards distraction using the body weight.
Remark : this manoeuvre is unsuitable for obese or very stiff patients who do not have much pelvic rotation.
A platform can be used if the therapist has difficulties in bringing his body weight above the patient (tall patient - small therapist).
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