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Lumbar Manipulation (Supine Technique)

Lumbar Manipulation (Supine Technique) Purpose: High velocity thrust maneuver used for patients who fit the TBC Manipulation criteria. Step 1: 0:50 With patient lying in supine, have them slide to the edge of the table closest to you. It does not matter which side you approach from, however it is important to be able to do the skill from both sides in case you have a patient who is limited to one side by pain, other injuries, etc. Step 2: 1:10 While holding the patient’s pelvis in neutral, move both legs towards the opposite side of the table. Step 3: 1:21 Instruct the patient to interlace their fingers behind their head, with their elbows pointing straight up in the air. Step 4: 1:33 While stabilizing the pelvis, assist the patient to sidebend away towards the opposite side of the table. Step 5: 1:46 Reach across the patient and feed your cranial hand (hand closest to patient’s head) through the patient’s arm and rotate the patient’s torso toward you. Use your caudal hand (hand closest to the patient’s feet) to maintain the sidebend by planting your fist against the table, with your forearm blocking the patient’s side. Note: Full rotation has been reached when the patients far ASIS begins to lift away from the table. Step 6: 2:14 Maintain this position, and move your caudal hand to the patient’s far ASIS. Apply a posterolateral and slightly inferior force through the patient’s ASIS to rotate the pelvis until endrange lumbar rotation. Once you have reached your endfeel, apply a high velocity, low amplitude thrust in the same direction. Follow lumbar manipulation with mid-range ROM exercises. Be sure to explain the technique to your patient prior to administering it. Cite the evidence in terms of safety and efficacy. Explain that the patient may experience a “pop” due to cavitation, but that it is not necessary for the technique to be successful. Patients meeting 4/5 qualifiers for the TBC manipulation group have a 95% success rate with lumbar manipulation with success defined as a 50% improvement in Oswestry score within 2 visits. Evidence: Flynn et al. Spine.2002;27:2835‐2843. Childs et al. Ann Intern Med. 2004;141:920‐928. Fritz et al. Spine J. 2006;6:289‐295. Cleland et al. Spine. 2009; 34:2720‐2729.