10.6 Lumbosacral joint (L5–S1)
Neutral positioning
Assume somatic dysfunction (S-T-A-R-T) is identified and you wish to use a gliding thrust to produce cavitation at L5–S1 on the right (Figs 10.32, 10.33).
1 Patient positioning
Lying on the left side with a pillow to support the head and neck.
Lower body. Straighten the patient’s lower (left) leg at the knee joint while placing the left hip in approximately 20° of flexion. Flex the patient’s upper knee and place the patient’s right foot behind the left lower leg (Fig. 10.34). 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 L5–S1 interspinous space, introduce right rotation of the patient’s upper body down to the L5–S1 segment. This is achieved by gently holding the patient’s left elbow with your right hand and pulling it towards you, but also in a cephalad direction towards the head end of the couch. Be careful not to introduce any flexion to the spine during this movement. Right rotation is continued until your palpating hand at the L5–S1 segment begins to sense motion. Take up the axillary hold. This arm controls the upper body rotation.
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