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
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