Lecture notes, lecture Lecture Mobilizations PDF

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Mobs/Manipulation Category Clinical prediction rules: -person is over 50 -pain worse with sitting and better with walking -initial onset of pain was bilateral in the low back -quadrant test + -LBP, may be distal into the leg but not past the knee (NRC) *thinking about mobs/manips just like we are thinking about muscle strength and stretching.. we intervene when there is an impairment or poor performance at the area * can use a mob/manip regardless of what classification the patient is in to try and help and increase motion or re-set alignment, remove a restriction is this someone that will benefit from solely mobs/manips? -possibly if someone has had LBP just for about under 2 weeks or so, but more likely they will need more than just that intervention (perhaps some manual therapy and exercise) Type I dysfunction: SB and rotation in the opposite direction, 3 or more levels Joints closed on the side that the SB mechanic is to Neutral dysfunction, present without flexion or extension but adding these motions does not make it go away TP palpation in neutral: more prominent left TP’s – rotated left Still prominent when you have them stand and bend forward Major motion loss if they cannot be in neutral without TP prominence on one side __RS left (rotated left) – prominence on L5 left side in neutral, major motion loss if they are stuck in flexion and cannot extend, then they are FRS (named by position stuck in, not motion loss of extension) flex forward and both sides of facet are symmetrical, when you bend back to extend, the left facet comes back and the right side is stuck in flexion – asymmetrical lumbar gapping technique, side lying so the dysfunctional right side is facing up (tight muscles with closed facet joint) gapping the joint – right facet interspinous space of L5/S1, in the spine we name motion by the top segment FRS left – prone press ups, positional distraction – holding position for 30 secs to a minute with pillow under lumbar spine Work on chops and functional diagonal movements once you improve mobility at the segment EX: SB right, rotate left Myofascial: Muscle spasms cause SB towards that side, rotate away from it Bird dog in quadruped to get weak muscles to contract on the targeted side, side bridges on that side

Type I mechanic is typically a compensatory problem and happening secondary to another problem Type II is a primary problem, usually adjust them first if the person has both type I and type II problems

ERS- same side is the prominent side (TP’s felt) EX: SB left, rotate left– place them on their right side to treat the left (stuck in extension) FRS- opposite side is the prominent side (TP’s felt) EX: SB left, rotate left – place them on their right side to treat the left (stuck in flexion) Joint stuck closed – gapping (perfect for ERS) MET better for FRS type II Facet joints in the lumbar spine can be opened up or closed in a different way ERS and FRS – type II mechanics MET technique will be best for FRS **ROTATION IS THE POWERFUL COMPONENT TO OUR MOBILIZATION AND WHAT WE WANT TO ADDRESS WITH WHAT SIDE NEEDS TO BE STRETCHED AND OPENED UP two problems – type II and type I, deal with type II first cant forward bend so I must be stuck in extension at L5 (ERS right) right side is dysfunctional so the right side faces up in sidelying type II dysfunction can be treated with type I intervention of gapping place dysfunctional side up and just do the gapping mobilization (rotating right if right side is up) FRS L at L1, what would be the SB and rotated above or below look like? ** Above L1 would be SB right and rotate left (type 1) SB left and rotate right below L1 (type 1) TP’s prominemt on right side below L1 and left side above L1

Muscle energy technique and left side is the dysfunctional side EX: L5 is FRS Left – cannot extend back symmetrically, right side is stuck open...