Continuing Education for Osteopathic Physicians Greenman | Osteopathic Principles and Practice Greenman

NonNeutral Dysfunction FRS-Left

Restriction of Motion During Backward-Bending -- If a right facet does not close normally, but the left does close normally, left sidebending will be possible but right sidebending will be restricted. Since rotation is coupled to sidebending in the lumbar spine, rotation will also be restricted by facet joint dysfunction. The segment is said to be restricted in extension, rotation right, and sidebending right. The positional diagnosis is FRS-Left, and the motion restriction is ERS-Right.

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 backward at the waist. As the patient increases the amount of backward-bending, the left transverse process becomes more prominent and moves inferior when compared to the right. When you have the patient bend forward, 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 forward, both facets are opened appropriately. The position of the transverse processes is symmetric because there is no rotational component associated with forward-bending.
When the patient bends backward, the left transverse process moves posterior and inferior, indicating that the right facet has not closed properly.
Because the right facet has not closed properly, we see left rotation (with left 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 right, sidebending right. The positional diagnosis is FRS-Left, and the motion restriction is ERS-Right.

No commercial support was received for the development of this content. The developers and presenters have no conflicts to disclose. This product is intended for instructional use only. It is not designed for clinical or diagnostic purposes. The authors, producers, and publishers of these materials shall not be held liable for any loss and/or injury arising from the use of information and procedures contained in these programs.