by Tyler Cymet, DO, FACOFP

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    00:01 It’s very common to have people come in complaining of lumbar issues, low back pain and there are a lot of things we can do.

    00:07 Whether you’re doing a myofascial or high velocity, you always start with understanding the range of motion and what the muscles feel like.

    00:15 You want to feel to see if there's any area of asymmetry, any issues with the range of motion of the lumbar spine, any tissue texture changes, temperature changes. Those are all important things to note.

    00:27 I’m going to start in treating lumbar generally with some myofascial and either a parallel myofascial, a general massage type of the back and kneading of the long muscles of the back.

    00:42 Usually you start with the long muscles, the longissimus, spinalis, and iliocostalis.

    00:46 Then you get to the smaller muscles, the multifidus and the rotatores that go single segments. You may actually check each segment to see what kind of motion you’re going to get both side bending and rotation.

    00:58 When you get to iliac crest, you know that’s about the level of L4, L4-L5, also important when you’re doing spinal taps. Check the motion of the sacrum on the pelvis and the sacrum on the lumbar spine.

    01:25 A lot of people like doing counterstrain points on the back because it’s not very difficult and easy to do on people who don’t have the muscle mass or the ability to move around very well.

    01:38 The counterstrain points, L1 is on the spinous process of the first lumbar vertebrae, L2 on the second, L3 on the third, L4 on the fourth, L5 on the fifth.

    01:50 There’s also a counterstrain point for L3 just lateral to the sacrum on the iliac.

    01:57 L4 also has a point lateral on the iliac bone. L5 has one about the point of S3.

    02:06 When dealing with counterstrain points, you want to find the counterstrain point, find the area of tenderness. Then you want to get to the point where you can relieve that by approximating the points and seeing if that will decrease it. Introducing some rotation or side bending can also help and you find the area of ease.

    02:28 So after counterstrain points, another thing we can do is called muscle energy.

    02:34 When you want to do muscle energy, you want to use the patient’s own muscle to free them up and to help make them more comfortable.

    02:41 So, let me have you lay on your side facing towards me.

    02:44 I’m going to have you bend this leg and have this leg use as a fulcrum.

    02:49 So now, it’s locked. I can feel where you may have areas of tenderness or restricted motion. I could drop the leg off to use that as an additional force for more energy and hold them in place, or I could stabilize, rock and roll, and then have him twist a little bit this way. Good.

    03:14 Now, that I’ve got an area where I’m treating, push towards me.

    03:19 Twist towards me, good, and relax. You see it goes back further than before.

    03:24 Push towards me again, one, two, and three, and relax. Good.

    03:29 Push towards me again, one, two, three, and relax.

    03:33 Each time, I get more motion as the muscle contracts and relaxes.

    03:37 Another thing I want to point out is high-velocity, low-amplitude.

    03:42 When you do high-velocity, low-amplitude, you always do myofascial or some other type of muscle loosening technique first.

    03:48 If you want to do muscle energy, you have to localize.

    03:51 Find the area you’re going to treat. I'm going to have you drop this hand like this.

    03:58 Grab the back of my elbow. I’m going to push them out, good, and relax.

    04:03 Let go of this arm. This goes all the way down against your chest. Got you.

    04:08 So once I’ve got him here, take a deep breath in and out. There we go.

    04:16 That’s a high-velocity, low-amplitude lumbar release.

    04:20 Those are different ways of treating the lumbar spine.

    04:23 Thank you.

    About the Lecture

    The lecture Lumbar by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region.

    Author of lecture Lumbar

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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