Patient positioning and spinal locking for lumbar spine rotation manipulation

High velocity low amplitude (HVLA) thrust techniques are widely used by many manual therapists to treat low back pain. There is increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain. HVLA thrust techniques are associated with an audible release in the form of a pop or cracking sound that is widely accepted to represent cavitation of a spinal zygapophyseal joint. This audible release distinguishes these techniques from other manual therapy interventions. When using long lever HVLA thrust techniques spinal locking is necessary to localize forces and achieve cavitation at a specific vertebral segment. A critical factor in applying lumbar spine manipulation with minimal force is patient positioning and spinal locking. A knowledge of coupled movements of the lumbar spine aids an understanding of the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation. Excessive rotation can result in pain, patient resistance and failed technique. This masterclass presents a model of patient positioning for the lumbar spine that minimizes excessive use of rotation to achieve spinal locking prior to the application of the thrust.