Starting position:
- Patientsitswiththighssupported,kneestogether,andarmscomfortably behind back.
- Therapiststandsbesideandclosetothepatient,perhapswithoneleg up on the treatment table.
Movement sequence:
- Patientisaskedtosagorslump;gentlehandpressurebytherapistcanguide the movement to obtain a bowing of the spine rather than hip flexion.
- Patientisaskedtolexhisorherheadandneckforwardinachin- to-chest motion.
- Patientisaskedtoperformankledorsilexionandthenextendthe knee actively as much they are able to within symptom tolerance.
Structural differentiation:
- Basedonwherethesymptoms(ifany)arelocated.
- Ifdistalsymptomshavedeveloped(e.g.,knee,posteriorthigh),thehead and neck are released from flexion and any change in the distal symptoms would constitute a positive structural differentiation.
- Ifproximalsymptomshavedeveloped(e.g.,neckandupperback pain), the ankle is released from dorsiflexion and any change in the proximal symptoms would constitute a positive structural
differentiation.