[CLINICAL PEARL] A Novel Technique to Improve Lumbar Lateral Shifts | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

[CLINICAL PEARL] A Novel Technique to Improve Lumbar Lateral Shifts

Quick case summary:

  • Previous patient for left sided lumbar pain and radiating complaints
  • Normally centralized and abolished with left sidegliding
    • had loss of ability to load the left lumbar spine in sidegliding in standing
  • Had resolved twice in the past with simple repeated motions and no manual therapy needed.
I ended up doing an "emergency" visit to the gym we work at to see him for an acute lumbar flareup. To my suprise, when he stood up, he was flexed and laterally shifted to the left. I was even more surprised when he pointed to the left side when I asked him which side was bothering him.

In the MDT system, ipsilateral lumbar lateral shifts do not have as good as outcomes. We all know that sometimes pathoanatomy does matter, and if a lumbar lateral shift IS discogenic, and they are shifted TO the same side of pain, shift correction means unloading the involved side and potentially further irritating a protruding disc. I'm not going to say it's going to cause a blow out, but typically they do not do well with repeated loading strategies. I've seen 4 ipsilateral shifts in my career, one was simple, two went to surgery (both had neuro signs and leg pain), and this one.

I kept my cool, and with a smile, said, "Let's see what can be done here."
I first tried some prone unloading, whether it was modified hips offset or lumbar roll to unloading the painful left side, both reduced his constant 8/10 pain to 1/10. However, upon WB and walking around for less than 2 minutes, he was fully shifted and not able to tolerate being upright at all.

As a last ditch effort, I thought to try one of the stabilization exercises I show to lumbar lateral shifts or people who respond to ipsilateral loading, unilateral carries. However, in a gymnastics facility, there usually aren't weights heavy enough, especially for an ex-football player. My girl's coach is strong enough for them to do pull overs on his outstretched arm. So I decided to pull down on his left arm, causing activation of his right trunk and hip muscles. In my mind, I thought it would straighten him, but was unsure how his nervous system would perceive the load to his painful, shifted side.

I started with light pulling inferiorly, but gradually increased to the point where I was using probably 80% of my body weight. You can see in the video, he's a big strong dude. To both of our suprise, he not only straightened out (in WB no less), but it also reduced his ispilateral lumbar pain from 8/10 to 0-1/10 mild ache. After a few sets, he was almost completely upright, and was able to walk around the gym for 3-4 minutes with pain remaining improved.

I instructed him on hourly or more performance of this in the gym by lifting up on balance beams and the vault table, things that were bolted to the floor and wouldn't give. He repeated this at home with as heavy objects as he could find. The next day, he was able to put on and tie his shoes. Follow up 1 week later verbally, he was fully upright, his right trunk was sore, but he was back to coaching.

I don't know if this works for lumbar ipsilateral shifts in general, but surmise it could work for either lateral shift (contralateral or ipsilateral) - most likely without radiating pain. They don't come walking in my door very often, so I wanted to show this clinical pearl and let social media do it's thing. Report back here on the facebook page, instagram, youtube, or reach out to me on any of my sites and let us know if this works for you as well as it did in this n=1.

Happy loading!

A Novel Technique to Improve Lumbar Lateral Shifts

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