Patient sitting at the edge of the table with the neck and trunk flexed, arms behind the back.
Therapist stabilizes the head and neck in flexion and passively straightens the leg to the barrier.
The therapist then immediately releases the tension by bending the knee.
Therapist repeatedly straightens and bends the knee 8-10 times.
Patient is then instructed to sit up tall and rock the pelvis forward (6:00) and backward (12:00) to release any tension in the low back.
Repeat this sequence with the other leg and then with both legs.
Further mobilization can be done by holding dorsiflexion of the ankle while straightening of the knee.

Counter Stretch with Manual Pressure at L5 or L4

Patient stands with the feet approximately hip width apart and places both hands on top of a counter or table top with the hands shoulder width apart. Patient pushes their hands against the table to assist in extending the thoracic spine.
Patient instructed to bend their knees but keep the heels flat on the floor, lift their sit bones up and back, towards the ceiling to achieve a neutral spine.
Actively the patient straightens the elbows and attempts to elongate the spine, dropping the chest towards the floor.
Finally, have the patient straighten the knees while maintaining a neutral lumbar spine, keeping the sit bones lifting towards the ceiling.
Patient notes where they feel pain
Therapist then applies strong PA pressure on the spinous process of L5 and the patient attempts to straighten the knees again and reports any change/improvement in pain behind the knees or down the leg.
If there is no change in symptoms therapist applies unilateral PA pressure on the lamina of L5, first on one side then the other and patient reports any change in symptoms
If no change is reported with manual pressure at L5 the process is repeated at L4
The goal is for the patient to report an improvement in their symptoms (less pain behind the knee or leg) when the therapist maintains a PA glide at L4 or L5

Nerve Glides