There are many techniques devised for manipulation of the lumbar spine in extension. It is not important which technique is used, provided the technique is performed on the properly selected patient and applied in the correct direction. The technique that I recommend is similar to the first two manipulations described by Cyriax for the reduction of a lumbar disc lesion.
The patient lies prone as for procedure 1. The therapist stands to one side of the patient and, having selected the affected segment, places the hands on either side of the spine as for the technique of extension mobilisation (procedure 7), which is always applied as a premanipulative testing procedure. If following testing the manipulation is indicated, the therapist leans over the patient with the arms at right angles to the spine and forces slowly downwards until the spine feels taut. Then a high velocity thrust of very short amplitude is applied and immediately released.
Fig. Extension manipulation.
The effects of the external force and the reasons for its use are the same as for procedure 7. When the desired result is not obtained with the mobilising techniques, manipulation is indicated under certain circumstances.
The extension thrust is used by many manipulators, and there is difference of opinion regarding the structures that may be influenced by this technique. Cyriax states that it reduces derangement of an annular fragment of the disc. Others propose reduction of facet locking, tearing of adhesions and reduction of nerve root entrapment. Whatever the true mechanism may be, properly selected patients often experience a click or a dull thud. In most instances the click is followed by a change, usually an improvement, in the patient’s signs and symptoms.