Techniques to Increase Lumbar Flexion

Movement PRECAUTION: If flexion of the spine causes a change in sensation or causes pain to radiate down an extremity, reassess the patient’s condition to determine
if flexion is contraindicated.
Indication To Stretch Lumbar Extensors
Procedure  Bring both of the patient’s knees to the chest  Hook-lying. Have the patient first bring  Quadruped (on hands and knees). Have the patient
by lifting under the knees (hip and knee one knee and then the other toward the perform a posterior pelvic tilt without rounding the
flexion). chest, clasp the hands around the thighs, thorax (concentrate on flexing the lumbar spine, not
 Flexion of the spine occurs as the hips are flexed and pull them to the chest, elevating the the thoracic spine), hold the position, then relax.
full range and the pelvis starts to rotate sacrum off the mat. The patient should  Repeat; this time bring the hips back to the feet, hold,
posteriorly. not grasp around the tibia; it places and then return to the hands and knees position.
 Greater range of flexion can be obtained by stress on the knee joints as the stretch  This also stretches the gluteus maximus, quadriceps
lifting under the patient’s sacrum with the force is applied. (‫علشان اللي عندهم خشونة‬ femoris, and shoulder extensor muscles.
lower hand.
Application

Procedure  Kneel on your hands and knees. Let your head fall forwards and arch your  Sit upright in a chair, with legs separated.
back upwards.  Slowly round the upper back and begin to lean forward.
 Continue to bend at the waist and lower the head and abdomen between the
legs and below the thighs.
Application
 Techniques to Increase Lumbar Extension
Movement PRECAUTION: Do not perform if extension causes a change in sensation or causes pain to radiate down an extremity
Indication To Stretch Lumbar Flexors
Procedure  Supine, with a foam roll placed longitudinally down the  Standing, with the hands placed in  Prone, with hands placed under the shoulders.
length of the spine. If the patient cannot balance on the roll the low-back area. Instruct the Have the patient extend the elbows and push
or experiences tenderness along the spinous processes from patient to lean backward. the thorax up off the mat but keep the pelvis
pressure, tape two foam rolls together. down on the mat. This is a prone press-up.
 The patient elevates both arms overhead in a  This exercise also places the hip flexor muscles
“touchdown” position and allows gravity to apply the and soft tissue anterior to the hips in an elongated
stretch force (Fig. A). position, although it does not selectively stretch
 The patient then abducts and laterally rotates both these tissues.
shoulders (90/90 position) so the hands are facing the
ceiling (Fig. B). This position also stretches the pectoralis
major and subscapularis muscles.
 Breathing exercises can be added to mobilize the ribs.
Application

Procedure  Quadruped (hands and knees). Instruct the patient to allow the spine to sag,  Sit on a Swiss ball and slowly roll the ball forward while leaning back.
creating lumbar extension. Allow your back and shoulders to rest on the ball and your arms to hang to
each side.
Application
 Techniques to Increase Lateral Flexibility of the Spine
Indication To Stretch the lateral trunk area.
Procedure  The patient is side-lying with the tight region on  Heel-sitting. Have the patient lean forward  Prone. Stabilize the patient (manually or with a
the top and a rolled towel or pillow supporting the so the abdomen rests on the anterior thighs; belt) at the iliac crest on the side of the
portion of the trunk. the arms are stretched overhead bilaterally; tightness.
 The top arm is placed overhead, and the top leg and the hands are flat on the floor. Then have  Have the patient reach toward the knee with
is in extension. Increasing or decreasing the size the patient laterally bend the trunk away the arm on the normal side while stretching
of the rolled towel or pillow can alter the degree of from the tight region. the opposite arm up and overhead.
stretch.  Hold the position for a sustained stretch.
 This position is held for anywhere from 5 to 15
min, depending on the patient’s tolerance.
Application

Procedure  Standing, With your feet shoulder-width apart, then slowly bend to the side  Sit upright in a chair.
and reach over the top of your head with your hand. Do not bend forward.  Interlock the hands behind the head, with the elbows in a straight line
across the shoulders.
 While keeping both elbows back and in a straight line, laterally flex the
waist and move the right elbow toward the right hip.

Application
 Techniques to Increase Lateral Flexibility& Rotation of the Spine
Indication To Stretch the lateral trunk area.
Procedure  Position the patient in hook-lying with hips  Sitting on the ground or in a chair. A. Stand with your feet shoulder-width apart. Place
and knees flexed and feet resting on the table.  If performing this exercise in a chair, the patient your hands across your chest while keeping your
 Push both of the patient’s knees laterally in uses a straight backed chair without arms. The feet back and shoulders upright. Slowly rotate your
one direction until the pelvis on the opposite are firmly planted on the floor, and the trunk is shoulders to one side.
side comes up off the treatment table. rotated toward the back of the chair. With one B. Stand with your feet shoulder-width apart. Place
 Stabilize the patient’s thorax with the top hand placed on the chair back, the other hand is your hands above your head while keeping
hand. placed on the lateral knee as shown in figure. The your back and shoulders upright. Slowly rotate
patient uses the hands to provide the stretch. your shoulders to one side
Application
A B

Quadratus Lumborum Stretching Techniques

Indication To Stretch the lateral trunk area.
Procedure  The patient is asked to adopt the  The right foot is placed behind the left foot  The patient sits on the floor. One thigh is parallel to the wall
shape of a (banana); this is achieved for balance. with the knee flexed so that the sole of the foot of that leg is
by the patient assuming a side-line  It is important to keep the left iliac crest placed on the inner thigh of the opposite leg. The side being
supine position, with their right hand (pelvis) down. stretched is adjacent to the wall.
placed underneath their head and  Adding in left rotation of the lumbar spine  The arm farther from the wall is anterior and medial to its
their right leg over their left leg. The would increase the efficacy of the stretch. ipsilateral leg, and the hand nearest the wall is placed on the
left leg overlays the edge of the table. wall to push the trunk laterally, away from the wall. The
hips remain on the floor and the pelvis remains in neutral.
Application