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.
Whether you’re doing a myofascial
or high velocity, you always start
with understanding the range of motion
and what the muscles feel like.
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.
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.
Usually you start with the long muscles, the
longissimus, spinalis, and iliocostalis.
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.
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.
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.
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.
There’s also a counterstrain point for L3
just lateral to the sacrum on the iliac.
L4 also has a point lateral on the iliac bone.
L5 has one about the point of S3.
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.
So after counterstrain points, another thing
we can do is called muscle energy.
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.
So, let me have you lay on your
side facing towards me.
I’m going to have you bend this leg and
have this leg use as a fulcrum.
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.
Now, that I’ve got an area where
I’m treating, push towards me.
Twist towards me, good, and relax. You see
it goes back further than before.
Push towards me again, one, two,
and three, and relax. Good.
Push towards me again,
one, two, three, and relax.
Each time, I get more motion
as the muscle contracts and relaxes.
Another thing I want to point out
is high-velocity, low-amplitude.
When you do high-velocity, low-amplitude, you always do myofascial
or some other type of muscle
loosening technique first.
If you want to do muscle energy,
you have to localize.
Find the area you’re going to treat. I'm going to
have you drop this hand like this.
Grab the back of my elbow. I’m going to
push them out, good, and relax.
Let go of this arm. This goes all the way
down against your chest. Got you.
So once I’ve got him here, take a deep
breath in and out. There we go.
That’s a high-velocity,
low-amplitude lumbar release.
Those are different ways
of treating the lumbar spine.