Joint Manipulation: Lumbar Spine, Sacroiliac Joint and Pubic Symphysis

Introduction

This course describes joint manipulation techniques for the lumbar spine, sacroiliac joint (SIJ), and pubic symphysis. Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion; specifically glide). Research does imply that manipulations affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a rarely used technique.

Note, that the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes manipulation techniques that intend to reduce excessive stiffness of the lumbar spine (low back), SIJ, and the pubic symphysis (lumbopelvic manipulations), improve spine range of motion (ROM), improve lumbopelvic alignment, and potentially reduce hip dysfunction. For example, research has demonstrated a correlation between asymmetrical SIJ stiffness, asymmetrical hip range of motion, and a correlation between low back pain, and future lower extremity injury. These techniques may also be used in an integrated approach for improving lumbopelvic hip complex dysfunction (LPHCD) and lower extremity dysfunction (LED) including sacroiliac joint pain (SIJD), lumbar radiculopathy, iliotibial band syndrome (ITBS), femoroacetabular impingement (FAI), patellofemoral pain syndrome (PFPS), etc. Additionally, due to the relationship between lumbopelvic alignment and hip mobility, and the relationship between hip mobility and ankle motion during gait, these techniques may aid in the treatment of pes planus, Achilles tendinopathy, and plantar fasciitis.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Lumbar Manipulation
• Sacroiliac Joint Manipulation
• Pubic Symphysis (Shotgun) Manipulation

Sample Intervention: Left Asymmetrical Weight Shift

• Manual Release
  • Right Adductor Magnus Manual Static Release
  • Right Biceps Femoris Manual Static Release
  • Right Piriformis Manual Static Release
• Mobilization or Manipulation
  • Right Side Down Lumbar Spine Manipulation
  • Right Side Sacroiliac Joint Manipulation
• Manual Lengthening
  • Right Adductor Magnus
  • Right Piriformis
• Activation
  • Left Gluteus Maximus Activation
  • Left Gluteus Medius Activation
• Integration
  • Posterior Oblique Subsystem

Related Courses

Additional Joint Mobilization Courses

• Joint Manipulation: Cervical Spine
• Joint Manipulation: Thoracic Spine
• Joint Manipulation: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis
• Joint Manipulation: Elbow (Radial Head) and Wrist
• Joint Manipulation: Ankle, Midfoot, and Tibiofibular Joint

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning