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ANTERIOR DERANGEMENT/LUMBAR EXTENSION SYNDROME

RFIL
RFISITT
RFIS
RFIL with Clinician Overpressure
IF relevant lateral:
Rotation in Flexion
Rotation in Flexion Mobilization (sustained or rhythmical)
Rotation in Flexion Manipulation
FISS
Hip flexors stiffer than abdominals
Hip abductors stiffer than lateral abdominals
TFL stiffer than abdominals
Latissimus dorsi is stiffer than abdominals
Lumbar extensors utilized more than hip extensors
**Look at confirming tests in Book**
PPT
PPT with foot lift
PPT with heel slide
PPT with heel slide with foot 2 off table
PPT with B/L heel slide
PPT with B/L heel slide with feet 2 off table
Prone knee flexion while preventing anterior tilt
Quadruped Rocking
Wall slides with PPT
Shoulder flexion with PPT
Step ups with PPT
Avoid lumbar extension in: sit-to-stand, stairs, sitting (use back rest), standing (avoid
swayback)
IF relevant lateral:
Hip rotation stretches **Need specifics**
Prone hip lateral rotation (stretch TFL)
Avoid lateral flexion/rotation in: sitting (leaning to side), standing (hip adducted), rolling
in bed

Possible Somatic Dysfunctions


B/L Extended
ERSLeft
ERSRight
Neutral Group Dysfunction ERleftSRight
Neutral Group Dysfunction ERRightSLeft

POSTERIOR DERANGEMENT/LUMBAR FLEXION SYNDROME


Prone Lying
Sustained Extension
REIL
REIL with patient overpressure
REIL with clinician overpressure
Extension Mobilization
Extension Manipulation
IF relevant lateral:
REIL with hips off center
REIL with hips off center with patient overpressure
REIL with hips off center with clinician sagittal or frontal overpressure
REIL with hips off center Mobilization
REIL with hips off center Manipulation
SGIS
SGIS with patient overpressure
Manual correction of lateral shift
Lumbar spine is more flexible into flexion than hamstring and gluteus maximus muscles
are extensible
Swayback posture (Abdominals are stiffer than back extensors)
Hamstring muscles are stiffer than back extensors
Single knee to chest (Repeated hip flexion avoiding lumbar flexion may need towel
roll)
Shoulder flexion with inhalation to stretch abdominals
Prone shoulder and hip extension (Increase spinal extensor strength)
Quadruped rocking (Repeated hip flexion avoiding lumbar flexion)
Sitting knee extension (Avoiding lumbar flexion)
Hamstring stretch (15-20 minutes at a time; also avoiding lumbar flexion)
Standing forward bend using hip flexion rather than lumbar flexion
Avoid lumbar flexion in: sitting (may need lumbar roll or wedge), bending forward)
IF relevant lateral:
Hip abduction and lateral rotation from hip flexion
S/L hip lateral rotation
S/L hip abduction
Prone hip rotation with knee flexed
Lateral flexion with lateral support
Possible Somatic Dysfunction
B/L flexed

FRSRight
FRSLeft
Neutral Group Dysfunction FRLeftSRight
Neutral Group Dysfunction FRRightSLeft

ANTERIOR DERANGEMENT/CERVICAL EXTENSION SYNDROME


Rep Ret (sitting, supine, prone)
Rep Ret with patient overpressure (sitting, supine, prone)
Rep Ret with clinician overpressure (sitting, supine, prone)
Ret Mobilization (sitting, supine, prone)
Rep Flex (sitting, supine)
Rep Flex with patient overpressure (sitting, supine)
RFIL with clinician overpressure
Flexion mobilization
IF relevant lateral:
Flexion with lateral flexion or rotation
Flexion with lateral flexion or rotation with patient overpressure
Flexion with lateral flexion or rotation with clinician overpressure
Unilateral flexion mobilization
Rotation (sitting, supine)
Rotation with patient overpressure (sitting, supine)
Rotation with clinician overpressure (sitting, supine)
Rotation mobilization (sitting, supine)
Rotation manipulation (sitting, supine)
Long, weak cervical flexors; short upper cervical extensors
Could have tight abdominal muscles, long weak thoracic extensors
Could have tight levator scapulae
Could have increased use of levator scapulae over intrinsic cervical extensors/rotators
Sitting with back to wall capital flexion
Progress to include shoulder abduction and lateral rotation progress to resistance
(strengthening)
Or progress to include shoulder flexion (stretching)
Supine capital flexion
Supine capital flexion with head lift
(If dominance of levator scap: prone capital extension progress to quadruped capital
extension)
Avoid Cervical Extension in: sitting (esp. with computers check glasses, TV)
IF relevant lateral:
Sitting with back to wall cervical rotation
Supine cervical rotation
Facing wall, arms supported active cervical rotation

Avoid prolonged rotation while watching TV, using computer; avoid lateral flexion while
on phone; avoid 1 arm activities
Possible Somatic Dysfunctions
B/L Extended
ERSLeft
ERSRight
Neutral Group Dysfunction ERleftSRight
Neutral Group Dysfunction ERRightSLeft

POSTERIOR DERANGEMENT/CERVICAL FLEXION SYNDROME


Rep Ret (sitting, supine, prone)
Rep Ret with patient overpressure (sitting, supine, prone)
Rep Ret with clinician overpressure (sitting, supine, prone)
Ret Mobilization (sitting, supine, prone)
Rep Ret Ext (sitting, supine, prone)
Ret Ext with Patient Overpressure, sustained or rhythmical (prone)
Ret Ext with clinician traction and Rotation mobilization (supine)
IF relevant lateral:
Lateral flexion
Lateral flexion with patient overpressure
Lateral flexion with clinician overpressure
Lateral flexion mobilization
Lateral flexion manipulation
OR
Rotation
Rotation with patient overpressure
Rotation with clinician overpressure
Rotation mobilization
Rotation manipulation
Excessive recruitment of extrinsic cervical rotators and anterior and middle scalenes
Excessive recruitment of extrinsic neck flexors
Poor recruitment of intrinsic neck extensors during extension
Lower cervical flexion greater than upper thoracic flexion (flat thoracic)
Prone cervical extension
Quadruped cervical extension
IF relevant lateral
Sitting back to wall cervical rotation with UEs supported, raise chin slightly
Supine active rotation
Quadruped active rotation
Arms supported on wall with active cervical rotation
Increase thoracic slump, lean forward with hips in sitting-not neck
Possible Somatic Dysfunction
B/L flexed
FRSRight
FRSLeft

Neutral Group Dysfunction FRLeftSRight


Neutral Group Dysfunction FRRightSLeft

POSTERIOR DERANGEMENT /THORACIC FLEXION SYNDROME


Rep Ext (sitting, supine, prone)
Extension with patient overpressure
Extension with clinician overpressure
Extension mobilization
Extension manipulation
Others:
Retraction and extension in supine
Sustained extension in supine
Sustained prone lying in extension
IF Relevant Lateral
Rotation
Rotation with patient overpressure
Rotation with clinician overpressure
Rotation mobilization in sitting or in prone extension
Rotation manipulation in prone extension
Long thoracic paraspinals and scapulothoracic (middle trap, rhomboids) muscles
Short anterior axioscapular (pec minor/major) and axiohumeral muscles (esp. lats)
Short rectus abdominis
Prone trunk extension
Back to wall shoulder flex, abd
Quadruped rocking
Inhale to eleveate ribs, elongate abs
B/L shoulder flexion at wall
IF Relevant Lateral
Unilateral shoulder flexion in prone
SLS with control of torso
Standing trunk flexion to improve hip flexion over thoracic flexion
Shoulder flexion in quadruped
Possible Somatic Dysfunction
B/L flexed
FRSRight
FRSLeft
Neutral Group Dysfunction FRLeftSRight
Neutral Group Dysfunction FRRightSLeft

ANTERIOR DERANGEMENT /THORACIC EXTENSION SYNDROME


Thoracic flexion
Thoracic flexion with overpressure
IF Relevant Lateral:
Rotation
Rotation with patient overpressure
Rotation with clinician overpressure
Rotation mobilization in sitting or in prone extension
Rotation manipulation in prone extension
Thoracic extension occurs too easily
Increase abdominal strength/utilization
Engage abdominals to limit thoracic extension or excessive elevation of rib cage during
arm elevation (can be occurred in sitting, standing, quadruped)
IF relevant lateral
Unilateral shoulder flexion in prone
SLS with control of torso
Abdominal exercise with UE and LE motion.
Possible Somatic Dysfunctions
B/L Extended
ERSLeft
ERSRight
Neutral Group Dysfunction ERleftSRight
Neutral Group Dysfunction ERRightSLeft