Purpose:  To increase motion and decrease pain in the lumbar spinal segments.  

Start:  Patient in side-lying at edge of plinth with the symptomatic side up and their knees bent.  Therapist stands at side of plinth facing patient.  

Procedure:  The therapist palpates the target segment with their superior hand, then uses their opposite hand to passively move the patient’s legs into flexion until motion is felt at target lumbar segment.  The therapist should use their thigh to support the patient’s leg as it is passively moved into flexion. The patient is asked to straighten bottom leg into extension on plinth. Therapist places patient’s top leg down in flexion by locking the dorsum of the top foot behind the knee of bottom leg.  The therapist then places their opposite hand on the target segment where it remains for the rest of the technique. The therapist uses the patient’s bottom arm to passively move the patient into end-range rotation where motion is felt at the target segment, then instructs the patient to rest that hand being the patient’s neck. The therapist interlocks their elbow with patient’s elbow and rolls the patient toward the therapist.  Therapist uses one forearm at the patient’s lateral torso and the other forearm at the patients posterolateral hip to move the patient into further rotation. At end range therapist provides HVLA by dropping down 1-2 inches toward the patient.  

Comments:  If patient has shoulder pathology, the therapist should perform initial upper torso rotation with hand behind the patient’s scapula.