Top 5 Fridays! 5 Variations on the Hip Long Axis Distraction | Modern Manual Therapy Blog

Top 5 Fridays! 5 Variations on the Hip Long Axis Distraction

Ahh... hip LAD, our plain Jane good ol' friend. So easy to do, and effective for hip, knee, lumbar, as well as neurodynamic dysfunction. Let's mix it up a bit, shall we?
1) Distract in positions other than resting position

Who said mobilizations only had to be in resting position? (well other than Kaltenborn, Paris, Grimsby, and Maitland). Most of the hips you see will have a loss of hip IR from the excessive sitting with abduction and ER. Wind up the hip in IR and perform your long axis distractions in that position. Not surprisingly, it improves IR faster than traditional LAD performs in flexion, abduction, and ER.

2) Progress to hip thrust

It's faster (literally) and a natural progression of forces. Just make sure to stabilize the pelvis with a belt at the symphysis pubis with the belt attached to a table. This one actually requires a lot of force and speed, vid embedded below

Neurodynamics Time!

Not only will treating the neural container help neurodynamic movements, but you can affect the nervous system even higher up by incorporating other components.

3) Head components
  • if you are distracting the right LE, try having the patient SB the head/neck to the right, and then to the left, you may notice a slight difference in joint play
  • if a distraction/glide is uncomfortable, slack the nervous system (SB toward)
  • as a force/treatment progression, tension the nervous system (SB away, or nod head and progress to neck flexion)
  • you can also have both UEs overhead to further tension the nervous system, extend the elbows and wrists while you're at it
4) Ankle/knee components

  • another way to get the nervous system a bit more involved is to have the patient actively extend their knee and dorsiflex the ankle
  • this can be an effective pre-tensioning strategy prior to the standard sciatic tensioning SLR like neurodynamic stretch
5) Spinal Mobilization/gapping with LAD

  • this is a variation on Mulligan's SMWM (spinal mob with movement)
  • have the patient in sidelying, hip/lumbar flexion, lumbar rotation for gapping
  • this may be a two person technique
  • one may oscillate at the lower lumbar spine into gapping/SB with rot
  • the other is performing first SLR then LAD of the hip
  • this should be Sx free (other than a perceived stretch) and if it works may dramatically change SLR
Ok, so I cheated, 3, 4 and 5 are neurodynamics, but still 5 points! I'll try and get the last one shot or at least in pics. Hope this helps with some progressions of a previously vanilla technique!


  1. Hi Erson nice vid, how would you go with someone who had a total knee replacement with restricted hip IR? Can we still traction & apply an IR force?

  2. The force is distributed along the entire leg, so there is no reason why you could not use LAD on someone with a total knee. If you're not pulling so hard you wouldn't dislocate a normal knee, the TKA is fine. Before using STM, I used to distract TKAs as well.

  3. Great minds think alike. Try throwing some rhythmic high and low frequency oscillatory motions into the equation. Bob Marley is good to get some rhythm. There is a great metronome app too that helps to practice the oscillations to. Keep up the good work. Final race of the season coming up then Im on to the piece I promised you. Have a great weekend. I really like the belt technique for stabilizing. If you are ever in NYC please reach out as we have lots to discuss on the clinical front!!!