Lower body. Straighten the patient’s lower (left) leg at the knee joint while keeping the left hip flexed. Flex the patient’s upper hip and knee. Rest the upper flexed knee upon the edge of the couch, anterior to the left thigh, and place the patient’s right foot behind the left calf. This position provides stability to the lower body.

Upper body. Gently extend the patient’s upper shoulder and place the patient’s right forearm on the lower ribs. Using your left hand to palpate the L3–4 interspinous space, introduce right rotation of the patient’s upper body down to the L3–4 segment. Rotation with flexion positioning is achieved by gently holding the patient’s left elbow with your right hand and pulling it towards you, but also in a caudad direction towards the foot end of the couch (Fig. 10.24). Right rotation is continued until your palpating hand at the L3–4 segment begins to sense motion. Take up the axillary hold. This arm controls the upper body rotation.