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HVLA - Lumbar (L5-S1) Spine Manipulation Mamillary Technique - Rotation, Sidelying Technique

Lumbar Spine – L1-S1 side-lying Rotary Technique Setup Contact Point 1. Right Anterior pectoralis major muscle 2. Right Mamillary process of target segment 3. Right Iliac crest if operator using forearm as long lever applicator 4. Right Anterolateral thigh if operator using thigh as long lever applicator Applicator Short Lever: Hypothenar eminence of left hand Long Lever: 1. Forearm flexor wad OR 2. Anterolateral thigh Stabilizer: Heel pad of right hand Patient Position Left Sidelying Lower body: Left leg and spine in a straight line. Right hip and knee flexed slightly and placed just anterior to the lower leg Upper body: Introduce right rotation of the patient's upper body until your palpating hand at L3–4 begins to sense motion Operator Stance Stand close to the plinth; feet spread and one leg behind the other. Maintain an upright posture, facing slightly in the direction of the patient's upper body Palpation of Contact Point Place the thumb of your right hand against the right side of the spinous process of T3. Spread the fingers of your right hand to rest over the patient's trapezius muscle and clavicle Fixation of Contact Points Positioning for thrust Place your left forearm in the region between the gluteus medius and the gluteus maximus. Rotate the patient's pelvis and lumbar spine towards you until motion is palpated at the L3–4 segment. Rotate the patient's upper body away from you until a sense of tension is palpated at the L3–4 segment. Roll the patient ~15° towards you Levers Primary: lateral flexion away from operator Secondary: rotation toward operator Tertiary: cervical extension Additional: compression and exhalation of patient Adjustments for Pre-load and Thrust Immediately Pre-thrust Relax and adjust your balance Delivering the thrust Rotate the patient another 15° and then accelerate another ~15° when delivering the thrust. The operator simultaneously pushes the patient’s pelvis into left rotation with a short applicator while dropping bodyweight through his/her thigh (the long applicator). The direction of thrust is down towards the plinth. The heel pad of the operator against the patient's right pectoralis major does not apply a thrust but acts as a stabilizer only Technique Modifications - Stabilize upper body of patient with forearm contacting axillary region of patient Operator uses pelvic rotation and a long lever applicator of the forearm on the patient’s left posterior lateral glute during the thrust