This is a very useful technique to help with patients who have very stubbornly blocked extension. It may be performed in standing or lying.
Indications: The patient is unable to overcome blocked extension in derangement syndrome when treating with the extension principle.
Pt: Standing
PT:
- Mob belt placed around your hips and the patient's hips, standing behind the patient and off to the side slightly
- Mob hand on the level above the suspected restricted segment.
Technique:
- P/A pressure applied with the mob hand with simultaneous superior pressure as the patient active backward bends
- Use your hips to apply counterforce so the patient does not lose balance from the P/A force
- Apply both P/A and superior traction force during the entire 10-15 reps
- Attempt for at least 3 sets, recheck extension to see if they are now able to reduce or maintain derangement reduction on their own
Pt: Lying prone
PT:
- One hand on the abdomen (explain to patient before you put it there - they expect to be touched in the back, not the front!)
- Other hand on the corresponding segment above the suspected blocked level (hands should be at the same level anteriorly and posteriorly)
Technique:
- As the patient performs the repeated extension in lying, apply A/P force with anterior hand and P/A force with posterior hand
- Also perform superior traction force
- Both forces maintained during the entire 10-15 reps
- Attempt for at least 3 sets, recheck extension to see if they are now able to reduce or maintain derangement reduction on their own
Like any MWM, this should be pain free other than the feeling of a stretch. I have found this to be very useful with seemingly irreducible derangements!
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