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NonNeutral Dysfunction

FRS-Right

Restriction of Motion During Backward-Bending -- If something interferes with the capacity of either facet to close normally, restriction of backward-bending will occur. For example, if a left facet does not close normally, but the right does close 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 segment is said to be restricted in extension, rotation left, and sidebending left. The positional diagnosis is FRS-Right, and the motion restriction is ERS-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 backward at the waist. As the patient increases the amount of backward-bending, the right transverse process becomes more prominent and moves inferior when compared to the left. 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 right transverse process moves posterior and inferior, indicating that the left facet has not closed properly.
  • Because the left facet has not closed properly, we see right rotation (with right sidebending) of the vertebra, with the left 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 FRS-Right, and the motion restriction is ERS-Left. Click here to visualize this type of dysfunction from a -- Side view -- Back view -- Top view) .
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