The patient lies supine on the couch, and the therapist stands on the side to which the legs are to be drawn, facing the head end of the couch. The patient’s far shoulder is held firmly on the couch by the therapist’s near hand, providing fixation and stabilisation. With the other hand the therapist flexes the patient’s hips and knees to a rightangle and carries them towards himself, causing the lumbar spine to rotate. With the patient’s ankles resting on the therapist’s thigh the knees are allowed to sink as far as possible and the legs are permitted to rest in that extreme position. The lumbar spine is now hanging on its ligaments in a position which combines side bending and rotation. By pushing the knees further towards the floor the therapist applies overpressure to take up the remaining slack in the lumbar spine. Depending on the purpose for which the procedure is used, the position of extreme rotation is maintained for a shorter or longer period.
Fig. Sustained rotation/mobilisation in flexion.
The procedure is mainly used in derangement. Sustained rotation for about thirty to forty seconds provides the time factor required to allow alteration of the position of the fluid nucleus within the disc. In those situations where time is important in the reduction this procedure may effect relief that will not be obtained by the much quicker performed rotation thrust (procedure 12). During the period that rotation is sustained the patient should be watched closely and asked constantly about the behaviour of pain. Any sign of peripheralisation of symptoms indicates that more than enough time has been spent in this position.
The procedure may also be used as a mobilising technique in dysfunction, or as premanipulative testing in dysfunction as well as in derangement. In these cases the rotation is less sustained or performed in a rhythmical mobilising manner.
If a small therapist cannot reach across the patient to stabilise his shoulder, a seat belt fastened firmly across the patient’s upper chest provides adequate fixation. Alternatively, a second person may be used to hold the patient down.