L5-S1 Gapping and Manipulation Technique

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Manipulation Technique

• Ipsilateral will be considered the part of joint you will be manipulating.

Patient Position

• Supine
• Hands clasped behind
• Keep feet together and move feet contralaterally (towards the side you will rotate) to create a contralateral sidebend

Clinician

• Stand at the head of the table, facing the patient¹
• Place your arm between the window created by the patient’s forearm and shoulder on the patient’s ipsilateral side.
• Your hand will fall on their chest and you can use their sternum as a lever.
• Ask the patient to inhale then exhale
• During the exhale, bring patient into spine flexion, contralateral rotation by walking around the table to their contralateral side.
• Use your opposite hand to block the ipsilateral ASIS
• When you feel the patient lock, hold the position and thrust through the ASIS to HVLAT them into contralateral rotation.

Note

You can tweak this technique to bias thoracolumbar junction or lumbosacral junction by modulating the amount of spinal flexion. More flexion will bias L5-S1¹. Less flexion will bias thoracolumbar junction¹.

References

1.

Perkins N. Stretch Affect Clinical Internship. Published online 10-14-24.