A Great Paper on the Management of Persistent LBP!
This is an excellent comprehensive clinical paper by Jenny McConnell published in the journal “Manual Therapy” reviewing effective potential intervention for individuals with persistent low back pain & sciatica.
The suggested treatments include mobilization of the thoracic spine, the hip joints, gluteal retraining exercises and neural tissue unloading taping techniques.
Thoracic mobilizations into flexion in or out of the slump position may have an effect on the dura. It can be hypothesized that thoracic mobs are sometimes incredibly and immediately effective perhaps due to their effects on the sympathetic nervous system.
The Technique:
First evaluate the range of motion and symptoms during forward trunk bending… this makes for a simple outcome measure.
With the patient sitting at the edge of the plinth, apply cranial PAs while performing mobilization with movements a la Mulligan over multiple levels from T4-T10.
Never allow the mobilizations or the position to increase or peripheralize the symptoms. Increase in symptoms or peripheralization is contra-indicated.
After approximately one-minute of mobilizations, allow the patient to stand up and re-evaluate the range of forward bending and pain intensity.
When the technique works, immediate and dramatic incresaes in forward beding mobility should be noted. If there is no change, the technique either needs to be modified or abandoned.
Posted on: November 01, 2004
Categories: Lumbar Spine
