Therapy Lumbar Spine Sitting D

Have the person sit relaxed and ask them to actively lordose (extend) their lumbar spine. Perform the extension from a relaxed, straight-up seated position, as well as from a position of maximal kyphosis (flexion). Support this movement by guiding an active shift forward as a therapist, at various vertebrae levels. Ensure that the shift occurs in the correct direction, namely in the physiological direction of each vertebra. For instance, L5 and L4 move forward and slightly downward (considering the promontory has an angle of about 30 degrees relative to the horizontal plane), while L1 and L2 move forward and slightly upward.

The therapist places one hand on the person's left shoulder to ensure that the shift is executed as accurately as possible, with the body's centre of gravity above the support surface. The processus transversus of each underlying vertebra is located at the level of the interspinous space between two vertebrae. Palpate and push the right processus vertebra forward, resulting in a rotation to the left of that vertebra. With the performed extension and the shift forward on the right side, a lateral flexion to the left occurs, corresponding to a D-type movement.

A slight elevation under the left tuber ischiadicum causes the pelvis, os sacrum, and the lumbar spine on the left side to be lifted upward and placed in a lateral flexion to the left. Then, perform a guided active extension of the lumbar spine, making the third dimension of movement, a rotation to the left, evident. This rotation to the left can be manually supported by assisting the right processus transversum in the rotational component, as well as in the extension and lateral flexion (note: in the video, the processus spinosus is used as a reference point for the rotational component; this should be the processus transversus).