The Transversus: It's Not Just for Strengthening Anymore

I was performing the Mulligan Belt Traction with Pt Hip IR MWM yesterday. She is a lumbar foraminal stenosis with hip dysfunction in a capsular pattern on the same side. She has been improving steadily with IASTM to her lumbar paraspinals, hamstring, ITB, and MWM to her left hip.

While performing the MWM passively for 1-2 reps to test her movement, it was pain free. When I asked her to move with me, she stated the movement was painful in her lumbar spine.

A rule for any Mulligan MWM is that it should be 100% pain free. Instead of abandoning the technique, I instructed her on a transversus abdominus contraction. While actively contracting, she was able to IR her left hip during the technique with no pain in her lumbar spine. Her hip IR improved after 3 quick sets and remained better for her HEP.

Another patient I was treating several years ago had LBP and radiating right LE pain. After 6 visits of MDT and OMPT she was completely pain free in all ADLs except crossing her right LE over her left at the ankle; this caused radiating pain to below her knee. All repeated motions and neurodynamic testing was normal and pain free. I suggested she try the same activity with a transversus contraction which made it pain free. She performed this 2-3 times/day and within 2 days, it was firing as normal during this minimal ADL.

 Just a quick clinical pearl! Hope it helps with some of your patients!