Treatments

• PASSIVE TREATMENT:

  • Desired effects:
  • Reduce pain or hypomobility (due to short periarticular tissues)
  • Move joint to affect muscle and/or nerve tissue
  • Always respect SIN when choosing your treatment technique. This will help determine the starting position, duration, speed and repetitions of treatment.
• Passive physiological rotation:

  • pts in side lying (side with pain on top) with knees flexed
  • use knees (pull or push with your hips) to bring the back into a neutral position (no flexion or extension)
  • always stand in front of pts and lean into them to stop them from falling
  • find pts area of pain
  • rotate that area of pain whilst stabilising their body
  • if lower back pain - stabilise the shoulders, rotate lower back
  • if upper back - stabilise the shoulder, rotate upper back OR have pts in sitting
  • average = 3 x 30 seconds - do in accordance with SIN e.g. low sin = do it for longer
• PAVIMS as treatment:

  • same method as when its used as an assessment
  • if symptoms are more central or bilateral do a central PA force
  • if symptoms are more unilateral do a unilateral PA force
  • Transverse passive accessory for unilateral pain or restriction and can help induce rotation
  • if its high SINS do low amplitude and vice versa
• Sustain Natural Apophyseal Glide (SNAG):

  • Can treat using accessory glide combined with active physiological movement – useful for treatment in functional WB position, static or dynamic
  • Encourages pain free movement, particularly useful if aim is symptom relief into a direction of movement. also useful for a patient that is fearful of moving into a certain direction
  • Isolate level to be mobilised and thumbs either side onto the articular pillar or use pisiform onto the spinous process
  • Stabilise trunk with use of seatbelt
  • Patient then actively moves into desired direction
  • ~ 7 reps, monitor
• Sustain Natural Apophyseal Glide (SNAG) - 7 reps (in accordance to SIN):

  • pts sitting off edge of plinth
  • put belt around pts ASIS and you
  • place pts feet on a stool
  • find the level of pain you found during assessment e.g. L3
  • hook under that spinous process (can also do unilateral)
  • apply glide as pts slow goes into lumbar flexion
  • when glide is applied, it should feel better for pts - if not, theres no point in carrying on
  • for extension tell pts to place their hands onto their neck
  • glide whilst pts extends back