What Is Wrong With this Movement?
I have been treating the individual in the picture to the left for 4 visits following a forward bending injury. After 4 visits he has reported 90% improvements in pain and function. His treatment sessions have focused on neutral core posture with hip strengthening & retraining his squat, deadlift, and reaching patterns. On the date of this photo, he is no longer having low back pain, but complains of lower thoracic spine pain.
What do we see from the picture?
First, he is lacking forward flexion active range of motion. He should be able to touch his hands to the floor when bending forward. Second, he does not have a uniform spinal curve. Almost all of his movement is coming from his thoracic spine. The large hump in the middle back is a good indication that the lumbar spine is not flexing! In addition the location of his pain is at the transitional zone from the thoracic spine to the lumbar spine (TL Junction). Finally, this individual does not translate his hips posteriorly at the proper time. In the photo, some posterior hip translation is noted; however, this movement only occurs after the thoracic spine has ran out of room to move. Normally, an individual should lead the movement from their hips.
How our patient's move gives us so much information about their pain. At the end of the treatment, he could bend forward about 50% further with an improved uniform spinal curve. A key point to note: I did not directly work on his lumbar AROM, but by providing stability and motor control to the thoracic spine, his lumbar range of motion improved. This treatment session is a great example of the necessity to treat the area of dysfunction not pain!
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10/12/2015 11:00:19 am
Thanks for the great post.
10/12/2015 06:48:03 pm
Thanks Adam. Generally I do not have the patients flex their knees, but I am definitely not opposed to it. With any manipulation, I am looking to take up a relative amount of tension to maximize the effect of my intervention. Taking up the tension could be something as simple as having the patient cross their legs, cervical sidebending, or flexing their knees (as you mentioned). If the patient does not feel "locked out" I will try any variation of these tensioning strategies to take up more slack in the system.
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