NonNeutral Dysfunction ERS-Right
Restriction of Motion During Forward-Bending -- If a right facet does not open normally, but the left does open normally, right sidebending will be possible but left sidebending will be restricted. Since rotation is coupled to sidebending in the lumbar spine, rotation will also be restricted by facet joint dysfunction. The affected segment is said to be restricted in flexion, rotation left, and sidebending left. The positional diagnosis is ERS-Right, and the motion restriction is FRS-Left.
Diagnosis -- With your thumbs on the posterior aspects of the transverse processes of a lumbar segment that is suspected of being dysfunctional, you have the patient bend forward at the waist. As the patient increases the amount of forward-bending, the left transverse process becomes less prominent and moves superior when compared to the right. When you have the patient bend backward, the position of both transverse processes become more symmetric. We know that in flexion the facets are supposed to open, and in extension the facets are supposed to close. Knowing this we suspect the following:
When the patient bends backward, both facets are closed appropriately. The position of the transverse processes is symmetric because there is no rotational component associated with backward-bending.
When the patient bends forward, the left transverse process moves anterior and superior, indicating that the right facet has not opened properly.
Because the right facet has not opened properly, we see right rotation (with right sidebending) of the vertebra, with the right facet functioning as a pivot point.
This condition is usually due to hypertonicity of the short muscles, although there may be other myofascial components contributing to the somatic dysfunction.
We conclude that the segment is restricted in extension, rotation left, sidebending left. The positional diagnosis is ERS-Right, and the motion restriction is FRS-Left.
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