Those of you who may be applying a repeated motions exam to find a directional preference, or using a pure MDT approach will find that most cervical spines and lumbar spines respond to extension or some form of unilateral loading.
It usually does not matter what the x-ray or CT scan says. A lack of joint space, degeration etc, normally does not correlate with pain or function levels. An astute mentee noticed in his practice that sometimes it does. The question was, "Why do some stenosis patients respond to flexion?"
I gave my thoughts about Flexion Rapid Responders back in this post, here and here. Here are my current thoughts
- the brain is always taking various inputs and making one of two decisions 1) danger 2) safe
- things seem to happen when things add up faster than the brain can think "green light"
- in the case of stenosis, my thoughts are that
- limited hip extension
- limited thoracic mobility
- causes excessive WB and thus load to the lumbar spine
This also why many lumbar or cervical cases that have central or lateral stenosis still seem to respond to extension or loading rather than flexion or unloading. Extension for many patients regardless of what their spine looks like when they're lying in a tube, is still novel, depending on their day to day activities.
Keeping it Eclectic...