Managing Acute Lumbar Exacerbation

By popular request! Here is a treatment sequence I use to restore ability to load the lumbar spine when a patient walks (or hobbles) into the clinic forward bent and/or laterally shifted.

The goals are to

  • grade exposure to neutral --> mid range load --> end range load
  • variations are
    • roadkill with overpressure
    • roadkill with P/A
    • roadkill with overpressure and press ups
  • lumbar rotation mobilization (loading the involved side)
The goal is to restore ability to perform SGIS or some sort of standing/WB reset. In the least, you want them to be upright before they leave your practice. In my experience, if they are still forward bent and/or shifted when they leave, chances are they will when they return. Sometimes the pain levels do not change before the ability to accept load does. The pain will often go, being upright is paramount to restore first.