Lumbopelvic Manipulation technique

Original Editor - Jun Cesar Atienza

Top Contributors - Jun Cesar Atienza  

Purpose

To describe and demonstrate the supine lumbopelvic manipulation technique used in the Flynn et al[1] study in developing a clinical prediction rule for the use of this technique in low back patients.

Technique

  1. Patient lies relaxed in a supine position.
  2. Therapist stands on opposite of the side to be manipulated.
  3. Patient’s legs are crossed over each other, opposite leg over the other.
  4. The therapist faces towards the patient’s feet and stabilizes along opposite hip with elbow while side bending legs away from therapist.
  5. Patient is asked to clasp fingers together and place hands behind neck.
  6. The therapist then faces patient’s face and stabilizes along opposite (same as step 4) hip with elbow and places hands behind patient’s back by the shoulder blades.
  7. The therapist sidebends patient’s upper body away, while simultaneously rotates towards.
  8. Therapist then places opposite palmar hand along opposite ASIS to keep pelvis stabilized and locks elbow.
  9. Therapist places other hand along shoulder blade and continues to rotate patient’s upper body towards to engage restrictive barrier.
  10. As end-range barrier is sensed, therapist applies a high velocity low amplitude through the ASIS towards treatment table.

Illustrations

Figure 1
Figure 1 is taken directly from the Flynn et al study and illustrates the manipulation technique as described above.


Cleland manip pic.jpg
Figure 2 is taken from the Cleland et al[2] case report illustrating the same manipulation technique used for satisfying clinical prediction rule by Flynn et al.

Evidence

Flynn et al[1] developed a clinical prediction rule to identify low back patient that would benefit from the above described spinal manipulation technique. Out of 71 patients that participated, 32 had success with the manipulation intervention. The following 5 variables were identified to form a clinical prediction rule for patients with low back pain likely to respond favorably to spinal manipulation:

  1. Duration of symptoms < 16 days
  2. FABQ work subscale score < 19
  3. At least one hip with > 35° of internal rotation range of motion
  4. Hypomobility in the lumbar spine
  5. No symptoms distal to the knee

Based on the number of these variables present, the study calculated the probabilities of the manipulation being successful.  It concluded that a patient presenting with 4 out of the 5 variables would have a probability of 95%, but even if 1 out of 5 variables were present the likelihood of the manipulation being successful is 46%.  Table 1 is taken from the Flynn et al study and illustrates the clinical prediction rule and the probabilities based on the number of variables present.[1]

Image:CPR_table.jpg

Table 1

Recent Related Research (from Pubmed)

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References

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  1. 1.0 1.1 1.2 Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27:2835-2843.
  2. Cleland JA, Fritz JM, Whitman JM, Childs JD, Palmer JA. The use of a lumbar spine manipulation technique by physical therapists in patients who satisfy a clinical prediction rule: a case series. J Orthop Sports Phys Ther. 2006 Apr;36(4):209-14.