Low Back Pain

Technique Video Down Below!

Most people suffer from some form of neck and back pain during their lifetime just as common as a headache, stomachache, or knee pain. “Research indicates that approximately two of every three people who experience pain in the spine are unable to identify any specific event that may have caused their problems,” states Hamilton Hall, MD.  Back pain simply happens!

We do know there are some key elements to look at when a client comes into our practice with low back pain. Are the lumbar facets stuck? Is the sacral base level? Is there a sacral torsion? Are the hips unbalanced or rotated? A lot of our clients will have these dysfunctions if not all of them combined. This is due to a common compensation pattern that most follow.

Typically, what you will see in your assessments is the lumbar spine locked or stuck in extension, sidebent right and rotated left. The sacrum is usually deep on the right sacral base and high on the left. The right hip is anteriorly and inferiorly rotated which can sometimes cause a jam at the L5-S1 junction. This is the most operated disc in the body. You can see with these typical dysfunctions the pelvic ligaments can also lose their ability to hold the pelvis during certain movements which can lead to instability and low back pain.

TP02-Managing-Low-Back-Pain.pdf (snapuptickets.com)

Back Pain Simply Happens - Erik Dalton Blog

Below we will go into the techniques for assessments and treatment with these conditions listed above.

Lumbar Spine Assessment:

• The client takes their shoes off and stands with their back towards the therapist.
• The therapist places their thumbs facing each other on the client’s lumbar spine. One thumb on each side of the joint.
• Therapist asks the client to bend forward and touch the toes.
• Therapist watches the thumb to see if one side rises while the other one drops.
• The side that rises is the dysfunctional side.
• The dysfunctional side means they are stuck in slight extension but not always. The other part is they are side bent right and rotated left. So, you have a spine that is stuck in extension side bent right and rotated left.

Sacral Base Assessment:

• The client lies face down on the therapy table.
• The therapist places thumbs on both the right and left side of the sacral base. Usually around S2 area.
• Therapist places a slight downward pressure towards the table and monitors the thumbs to see which side is deeper.
• Typically, the right side is deep, and the left is slightly elevated.

Anterior and Inferiorly Rotated Pelvis Assessment:

• The client lies face up on the therapy table.
• Therapist locates the client’s ASIS and places their thumbs directly under the ASIS. The pointed side of the thumbs are facing each other to help envision a line going across the pelvis. If the therapist was to try and push up the ASIS would stop the thumbs from moving up. Then you know you are in the right spot.
• The therapist looks directly over the pelvis and thumbs to see which thumb is lower. The lower thumb is the dysfunctional side.
• The right side is usually the side of dysfunction. It is important to know which eye is the dominant eye. Whichever eye is the dominant eye the therapist will stand on that side of the client using the dominant eye to see which thumb is lower. If you are unsure which eye is dominant here is a fast way to know.

The Dominant Eye Test:

• Create a triangle with your forefingers and thumbs. With both of your eyes open, center this triangle on an object in the distance like a doorknob or a wall clock. Close your left and right eye. Whichever eye the object remains centered, then that eye (the eye that is open) is your dominant eye.

Treatment Techniques

Unlocking the Lumbar Spine:

• The client sits on the edge of the table or on a stool.
• Therapist ask the client to place the left hand behind the head, and the right hand on the left elbow.
• Therapist stands on the right side of the client and snakes the right arm through the clients arm to grasp the client’s left arm/elbow.
• Client leans forward while therapist monitor the lumbar spine to push against their fingers. The therapist hold the client over their arm.
• Therapist leans gently into the client to left sidebend the spine and positions their body halfway between the client.
• Therapist left palm is on the left side of the lumbar spine. Therapist then rotates the client towards them while applying light pressure on the lumbar spine.
• Client returns to neutral in the rotation but stays sidebent. Therapist rotates again and repeats until movement has increased.

Level the Sacral Base:

• Client lies face down on the therapy table.
• Therapist stands on the left side of the therapy table.
• Therapist places their hands on top of each other and places the palms on the clients left Inferior Lateral Angle (ILA) of the sacrum.
• Therapist ask the client to inhale. At the same time, therapist uses the palms to drag the sacrum inferiorly towards the feet and slight downward pressure.
• As the client exhales, the therapist applies consistent compressions on the ILA.
• Repeat process and reevaluate the sacral base.

Rotated Ilium:

• Client lies face up on the therapy table.
• Client bends both knees so the feet are flat on the table.
• Therapist stands on the client’s right side across from the thigh.
• Therapist snakes the left arm under the client’s right knee and rest the hand on top of the clients left knee.
• Therapist grabs the client’s right foot and leans their body to the right while keeping their hand on the left knee. This will lift the right hip slightly off the table.
• Therapist ask the client to gently pull the hip down towards the table to a count of 5 while therapist resist. After the count of 5 and client relaxes therapist leans a little more to the right with the intent of de-rotating the Ilium. Repeat 3-5 times.