Webinar: Advanced Mobilization in Lumbar Spine Pathology

Physiotherapy Webinars: Revision Notes

Check out the fantastic series from ‘Hands on seminars’

Advanced Mobilization in Lumbar Spine Pathology 
Kevin Okamura, PT, FACMPT, MCMT
Dimitrios Kostopoulos, PT, MD, PhD, DSc, ECS

Relevance to patient:


  • Is it appropriate?
  • Which tissues is  causing the pain?
  • Soft tissue
  • Joint
  • Nerve
  • Poor stability
  • Combination?
  • Are the diagnostic test reliable/valid?
  • What exercises will compliment the intervention?

Case Study

  • See slides (8.01 on webinar)
  • Assessment:
  • Active Physiological Movement ( back AROM)
  • Quadrant movements (combined movements)
  • Clinical usefulness of quadrant testing: Achieves unilateral end range movement (ie maximum end range of facet joint)
  • Neural test were normal
  • SI tests normal
  • Functional test : Single leg balance with knee bend- lateral shift of hips to left when standing on left. ?loss of stability.


  • TOP L5/ S1 segment
  • Weakness of left glut med,
  • Tight, hypertonic, trigger point formation  within gluts will create shortening effected in muscle – lose optimum position (length/tension)
  • By shortening muscles functionally places sacromeres in a shortened position (bio mechanical disadvantage – reduced strength and power generation – resting state of hypertonicity).
  • How to determine which segment (if any are problematic)
  • How do we treat effectively?


  • Passive Physiological Interverterbral movements (PIVIMs)
  •  Passive accessory intervertebral movements (PAVIMs)
  • These determines biomechanical segment restrictions.
  • PPVIMs
  • Palpating to feel gapping between interspinous space.
  • Lumbar facet joint = 2 glides
  • Posterior inferior, associated with extension.
  • Anterior superior, associated with flexion.
  • Direction of the glide is named by the superior bone of the segment.
  • If a facet joint’s PIVIM/PAVIM feels hypermobile or ‘stuck’ then it is appropriate for mobilization.
  • If the joint feels hypermobile, then stability testing may indicate that it is NOT appropriate for mobilisation.
  • Hypermobile joints need stabilization through strengthening exercises.

Case study –

  • Hypomobile right L5/S1
  • Loss of posterior/inferior glide at right L5/S1
  • Hypermobile L4/L5 and L5/S1 on testing
  • Hypermobile joints may require stability testing. Left L5S1 was unstable with left rotation
  • Locking the spine
  • Minimize movement at other joints above and below.
  • Locking upper level
  • Bottom lever
  • Grades 1-5
  • Mobilization force in 3 different planes.
  • Distraction
  • Posterior/inferior glide (restore extension)
  • Anterior superior glide (restore flex)



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