Audience Q&A: Lumbar Lateral Shift | Modern Manual Therapy Blog

Audience Q&A: Lumbar Lateral Shift

There has been something I have been meaning to throw out there to generate some discussion. I know what I (and other MDT trained clinicians) do for a lumbar lateral shift in terms of evaluation, treatment, and patient education.
My question for all of you out there is, for those of you who are not formally MDT trained, or have no exposure to it, what do you do?


From my education at the University of St. Augustine, I was taught positional distraction and given relevant scan study info showing that that position has maximal gapping unilaterally. However, there was no real progression or patient education, other than the typical avoidance.

I'm asking this because it's not often a very difficult lateral shift comes walking crookedly into your clinic. I'm currently seeing one who was seen in the clinic 1.5 years ago. Back then, he was fully corrected, the derangement was stable, and he returned to function after 8-9 visits.


This time around, after 6 visits, he returns back after each session either no better, or worse. On the last visit, he told me he can't take care of his daughter, who is 1 month older than my youngest. He said, "I can't be left alone with her." That hit me so hard, I spend 90 minutes with him trying various shift correction strategies. He left walking slightly more upright, with centralization of R LE complaints, but still had 5/10 pain.

So my question to you guys is more out of curiosity and less for advice, but that's always appreciated!

9 comments:

  1. In my Maitland training we do discuss how to correct lateral shift corrections. Side glides are one option, but are also taught that lumbar rotation mobilizations can also be effective in reducing lateral shits when side glides are not as effective. General rule of thumb is that if you are closing down the segment, then that side is down towards the table. For example, a right shift with contralateral pain would be initially treated with left side side down. Rotation in this way would theoretically produce left side glide (left side bend and right rotation). The position of the bottom leg can be biased more towards extension producing more lumbar extension as well. All the variables of flex/ext, LF, and rotation can be manipulated in the sidelying rotation mobilization to have the greatest effect on the comparable sign. A table that moves or a pillow above the illiac crest might also help to alter the persons position to allow for better treatment. In your NDT model Erson, this I think would/might even get to end range better than straight side gliding. The non weight bearing position might also be helpful for some individuals as well.

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  2. Another method that I learned about I think comes from Cyriax, but don't quote me on that. The treatment for a right shift is done in supine with both knees flexed and the right knee is positioned over top the left knee. The therapist is stride standing on the right side of the patient with hands on the knees and elbows up. Hands then push in opposite directions to further cross the legs. One can test repeated passive movements further into range of side glide/flexion. If appropriate response is noted, one then hold this end position for as long as is needed. For a right shift, right leg is crossed over the left, and v.v. for the left shift. This one has worked for me as well. It is a lot easier to hold for a long time than standing shift corrections, and is non weight bearing.

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  3. Can't picture this one Ben. Is it opening? Sounds like it from the description

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  4. Actually, this is what MDT calls rotation in flexion and is one of the final force progressions. Tried this a few times and also instructed it for HEP (held vs reps). It helps centralize but not abolish the pain. Advantages for NWB is end range is better tolerated. The disadvantages are that it's harder to hold the reduction when they get up off of the table.

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  5. Had to look in my notes before I posted it. I have trouble envisioning this one as well. The page is on lateral shift correction, so I would I don't think that it would be opening the side making the shift worse. I think that the correction comes from the torque on opposing legs, with the bottom leg moving from left to right in this example, which would cause a rotation in the lumbar spine closing down the right lumbar segments. That is how I am seeing it. I would test it out and see what you think. If it doesn't work, then just try it with the opposite set up and see what it does.

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  6. So the right leg is crossed over the left, then both legs move to the right? Seems kind of redudant

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  7. The right knee is pushed to the left and the left knee is pushed to the right.

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  8. Take a movie and upload it to youtube or your blog! I'm a visual learner!

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  9. I am too! I have been wanting to talk to you about this one, and see what you think. Seemed like a good time to do this.

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