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

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

Procedure:  Therapist palpates target segment with their superior hand, then uses 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 their bottom leg into extension on the plinth.  The therapist allows the patient’s upper leg to drop off the side of the plinth to preposition the patient into side-bend. 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 behind the patient’s neck. The therapist interlocks their elbow with the patient’s elbow.  The therapist uses their forearm at patient’s lateral torso and their opposite forearm at patients posterolateral hip to move patient into further side-bend. At end range the therapist provides a HVLA by dropping down 1-2 inches toward patient.  

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