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NMT: Lumbar


LUMBAR NMT
top 3 move mostly in flexion/extension
L4 and 5 have more rotation and lateral flexion

ASSESSMENTS

flexion
pt prone
crossed hands, block lower vertebra, shift higher with pisiform to sp
looking for glide and springy endfeel
can add blocks under ilia to tilt pelvis posteriorly

extension
pt prone
make pincher out of folded index finger and thumb
push p-->a on each sp feeling for glide and spring
can block greater trochanters to increase anterior tilt, arch back

rotation
push with thumb away from self
for L5, 4, maybe 3, grasp opposite iliac crest to bring joint to tension
for L2 and 1 use two thumbs, one on each side of spine, adjacent vertebrae
assess one direction rot from one side of table, then go to the other side of the table
no need for blocks

lateral flexion
use a rolling stool, pt prone, knees on my knee, laterally bend pt lumbar by moving legs
push with thumb on lateral sp in away from self
relieve tension between vert, must lat bend farther for each higher vert
there's not much movement in the lumbar, esp not in L1,2,3

SEATED assessments
useful for screening if pt is seated already
(prone is easier)
straddle table behind pt who is straddling table

extension
my forearm across pt shoulders, bring pt torso back
or have pt grasp hands behind neck and I grab elbows, ext torso
pincher grip push forward

flexion
pt hunch forward w arms crossed on chest
push up on sp with thumb

R lateral flexion
my R forearm on their shoulders
my L thumb on R side pushing to L

rotation
pt hug self, I grab elbows
rot pt to right, press sp to left
less rot higher

MAMMILARY PUSH
lesion side down (R rotation rstrx-->R side down, push on L mamm process)
hip to hip, traction shoulder up & back as needed
pisiform next to sp, sliding down side to contact m process
traction and pulse or weight drop/thrust

KNEE TO KNEE
more leverage so use if pt is larger than me
more removed from spine, less sensitivity
contact is sp
start with shoulders and hips stacked
hook pt top foot in bottom popliteal
hip flexed at least 90 degrees, hip tucked
doc stance 90 degrees from table
front leg by table above pt knee
back leg contacts pt knee to lever it downward
starting a motorcycle: kick
simultaneous two finger upward pull on sp

PUSH PULL MANEUVER
more suited for MET than grade 4 or 5 per Agresta:
put pt in twist and have them exert vs me

great for rotation restrx at thoracolumbar jct
pt side lies with lesion side down, bring pt back arm back
doc faces pt, winds caudal arm under pt arm, forearm across front of pt shoulder pinning them
locate upper of 2 vertebrae for push on SP
lower vert is pulled with rostral hand for pull on SP
knee to knee to traction lower body and thrust

EXERCISES

STIR THE POT
http://www.youtube.com/watch?v=3JEj7t6Cy9s

McGill Big 3 exercises: 1) curl, 1 knee bend, hands under low back, upper back curl
2) quadruped, on all 4 lift opp hand/leg, alternat
3) SIDE plank

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