The position of patient and therapist is the same as for procedure 7. By modifying the technique of extension mobilisation so that the pressure is applied first to the transverse process on the one side and then on the other side of the appropriate segment a rocking effect is obtained. Each time the vertebra is rotated away from the side to which the pressure is applied — for example, pressure on the right transverse process of the fourth lumbar vertebra causes left rotation of the same vertebra. The technique should be repeated about ten times on the involved segment and, if indicated, adjacent segments should be treated as well.
Fig. Rotation mobilisation in extension.
Also here the external force applied by the therapist enhances the effects on derangement and dysfunction as described for the previous extension procedures. The reasons for adding therapist-technique are the same as for procedure 7.
In general, unilateral techniques are likely to effect unilateral or asymmetrical symptoms sooner and more efficiently than bilateral or central techniques. But once centralisation of symptoms has taken place, treatment may be continued with central or bilateral techniques. Thus, in derangement rotation mobilisation in extension may have to be performed first to bring about centralisation of nuclear material in the disc. This is followed by symmetrical extension mobilisation to restore the nucleus to its more anterior position.
Occasionally a click is felt during mobilisation. A click often indicates a reduction of derangement, and we should immediately assess if this is the case. If the patient has improved significantly as a result of this technique, any further treatment may disturb the reduction and the treatment session should be terminated at this point.
During the procedure the patient may describe an enhancement of the pain by pressure on one side with a corresponding reduction of the pain by pressure on the other side. This is valuable information on which further treatment will be based. We must keep in mind that we are affecting the pain by increasing or decreasing mechanical deformation. In dysfunction an increase in mechanical deformation with certain limits is desirable and pain should be produced or increased with the application of the technique. In derangement an increase in mechanical deformation is extremely undesirable, and we should aim for a decrease instead with centralisation, reduction or abolition of the pain. Therefore, precise identification of the syndrome to be treated is essential to determine whether rotation mobilisation should be performed towards the painful or the painfree side.