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Orthopedic Tip of the Week

Orthopedic Tip of the Month


The patient lies prone with the upper body on a table, but with the legs over the edge (hips flexed 90 degrees) and the feet on the floor. The patient must relax the torso musculature. The clinician then applies direct force downward onto each spinous process in turn (starting at the sacrum, then L5, L4, L3, etc...) Unstable segments are identified when either the person reports pain or the clinician feels actual shear displacement, but the patient's reporting of segment-specific pain, in this case, is given more consideration. The patient is then asked to slightly raise the legs/feet off of the floor to contract the back extensor muscles. The clinician once again applies force on each spinous process. By virtue of their lines of action, the lumbar extensors will reduce shearing instability, if present. If pain is present in the resting position but then disappears or subsides with active cocontraction of the lumbar extensors, the test is positive. This test proves conclusively that activating the extensors stabilizes the shear instability and eliminates the pain. Now the trick is to incorporate these extensor motor patterns into exercise prescriptions to carry over to daily activities.

(Low Back Disorders, Evidence-Based Prevention & Rehabilitation Stuart McGill)


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