Other lumbar spine treatments

Below are several techniques that are less commonly taught at osteopathic schools and / or rarely tested on the COMLEX® exams. These lists are not fully inclusive but are meant to highlight some of the most common or useful applications of each technique.

ARTICULATORY

Diagnosis: Lumbar rotation somatic dysfunction

Note: this positioning is sometimes referred to as the “walk around” technique and can be used for multiple different treatment modalities (e.g., muscle energy, HVLA, articulatory techniques). For example, if a patient had a right-sided rotation restriction, you would instruct them to grab the back of their neck with the left hand and place their right hand on their left anterior elbow. You could then grab the upper portion of their left arm and use this as a fulcrum to more easily rotate (and possibly side bend) their torso.

With the patient seated, stand behind them at the side opposite their rotation restriction
Instruct the patient to place the hand closer to you behind their neck, and grab their anterior elbow with the other hand
Reach across the patient’s torso (under their opposite axilla) and grab the arm closer to you, just superiorly to the hand grabbing their anterior elbow
Place your other hand at the level of the dysfunctional vertebrae, on the transverse process closer to you
Instruct the patient to lean forward and relax
Pull the patient’s arm across their torso, causing them to rotate toward their restriction
At the same time, push anteriorly and laterally at the transverse process closer to you to further exaggerate rotation toward their restriction
Hold the patient in this barrier for about a second, then return to neutral
Repeat steps 6 and 7 until motion is normalized at the involved vertebra

BALANCED LIGAMENTOUS TENSION

Spinal-sacral tethering emphasis

With the patient lying supine, sit on the side of rotation
Place your caudad hand under the patient’s sacrum with the finger pads on the sacral base
Place your cephalad hand across the lumbar spine at the dysfunctional segment, with the heel of your hand and finger pads contacting the transverse processes
With the caudad hand, gently move the sacrum cephalad and caudad until a point of balanced tension is palpated
With the cephalad hand, gently lift upward (to assess flexion and extension), and gently rotate the dysfunctional segment to the right and left until a point of balanced tension is palpated
Hold this position until a release is palpated

SOFT TISSUE

Unilateral prone pressure

With the patient lying prone, stand at the side opposite of the area to be treated
Place palms of both hands (with one slightly overlapping the other) on the patient’s hypertonic lumbar paravertebral musculature
Exert a gentle force downward (into the table) to engage the tissues, and then laterally
Hold the force for a few seconds, then repeat steps 2 and 3 in a gentle, kneading fashion

Prone traction, lumbosacral method

With the patient lying prone, stand on either side of the patient
Place one hand at the base of the patient’s sacrum with fingers pointing toward the coccyx, and the other hand over the lumbar spinous processes with fingers pointing cephalad
Exert a gentle force downward (into the table) with both hands to engage the tissues, and then in the direction the fingers of each hand are pointing, creating distraction of the tissues
Hold the force for a few seconds, then repeat steps 2 and 3 in a gentle, kneading fashion
This can be repeated bilaterally by swapping hand placement and again moving the tissue in the direction the fingers of each hand are pointing

Prone pressure with counter leverage

With the patient lying prone, stand opposite of the side to be treated
Place the thenar eminence of cephalad hand on the patient’s lumbar paravertebral musculature
With the caudad hand, grasp the patient’s ASIS on the side to be treated and gently lift toward the ceiling
Exert a gentle downward and lateral force with the cephalad hand, perpendicular to the lumbar paravertebral musculature
Hold the force for several seconds and repeat steps 2–4 in a gentle, kneading fashion
This can be repeated bilaterally by swapping hand placement and again moving the tissue in the direction the fingers of each hand are pointing

Unilateral myofascial hypertonicity, seated rotation method

Example: Left-sided hypertonicity

Stand behind the seated patient, opposite of the side of dysfunction
Instruct the patient to place their left hand behind their neck and grasp their left anterior elbow with their right hand
Reach under the patient’s right axilla with your right hand and grasp the patient’s left upper arm
Place the left thenar eminence on the patient’s left hypertonic lumbar paravertebral musculature
Instruct the patient to lean forward and relax, allowing their body weight to rest onto your right arm
Direct a gentle ventral and lateral force with the left hand to create a perpendicular stretch while rotating the patient to the right with your right arm
Hold the stretch for several seconds and repeat steps 4–6 in a gentle, kneading fashion

Author: Arman Israelyan, OMS-III

Editor: Matt Lipinski, DO

Editor: Robyn Hughes, MScBMC

Other lumbar spine treatments

Videos

Notes