Manual therapy ppt

1

THE LUMBER SPINE

SNAGSSELF SNAGS

QURATULAIN MUGHALBATCH IV

DOCTOR OF PHYSICAL THERAPYISRA UNIVERSITY

2

INTRODUCTION SNAGS work directly on facet joints, that can

help a disc lesion. And assist Mckenzie response. During normal flexion of the spine the disc

distorts and becomes wedge shaped. The vertebral bodies proximate ventrally and

separate dorsally. BUT remain under the umbrella of above vertebra.

And facet joint must be mobile.

1.SNAGS

3

4

5

If the facet joints are hypo mobile, when the

flexion takes place, the vertebral bodies will be able to proximate anteriorly but unable to separate dorsally.

The disc may no longer under the above vertebral umbrella. And bulged posteriorly causing symptoms.

CONTINUE…

6

7

All techniques explanation must be given to

the patient. Their co-operation is needed. Tell patient your are going to move a vertebra

with your hand in such a way that the pain they feel with particular movt will disappear.

If you feel any pain they must tell you so that you can check your techniques or try another level.

PROCEDURES

8

Do not overdo the SNAGS. As soon as an improvement is brought about

on day one stop and see them two days layer. ‘’RULE OF THREE’’ ON DAY ONE WHEN treating a pt with marked

pain and thus distress we only use our pain free techniques three times as a precaution.

On subsequent visit you may choose to SNAG 10 times.

PROCEDURES

9

You should use McKenzie approach when a pt

has lumbar 4/5 lesion with a lateral shift. To SNAG lumbar(middle) and thoracic(lower),

we require a plinth and a belt that can adjusted in length.

Belt should be 2.6meters(8feets) in length and made up of car seatbelt material.

PROCEDURES

10

In sitting and standing.

If problem with movement are only present when standing then snag are only in done in standing.

If they have movement problem when sitting as well then your initial therapy would be in sitting and would progress to standing.

ACTIVE MOVEMENTS

11

(1).To increase flexion and/or decrease the pain associated with his movement.(a) In sitting: The pt sits on a plinth with his legs over the side. You stand behind and place a belt around him

and yourself. tn placing the belt around the pt’s lower

abdomen keep it below the ASIS for comfort. The belt below your hip joints. Depents on your stature.

DESCRIPTIONS

12

The ulnar border of your right hand is now

placed under the spinous process of the vertebra above at the suspected spinal segments.

Your other hand should placed on the bed to the left of the pt.

The pt flexes forward until the pain is felt.. He now back off a little from his position.

13

You now apply a gliding force with your right

hand up along the facet treatment plane as he again flexes.

If treatment is indicated, you are on the right segment and the direction of force is correct, he will painlessly flex to almost full range.

If there is pain try another level. Sustain flexed position for a few seconds and

maintain your facet glide until yhe pt is again erect.

14

When there is no pain, repeat just three times

and that would be all that you would do on the pt first visit.

15

16

17

B. IN STANDING

18

19

20

21

SELF SNAG

22

23

24

MULLIGAN :MOBILIZATION OF SPINE VOL:II

REFERENCE

25