Lumbar manipulation for internal derangement, the "reverse stretch"
How to perform the lumbar "reverse stretch" manipulation?
This manipulation can be very helpful to reduce an internal derangement in the lumbar spine.
>>> All other spinal manipulation techniques are illustrated in a series of practical films
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.
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.
Starting 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 unsuited 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).
>>> When to us which manipulation technique, how many times...