I have spoken many times before about using Type I and Type II Motion in the thoracic spine. I have to say it is one oif the most useful things you can use, whatever the patient’s pain or dysfunction. Although this may get used in response to an injury, the most direct use for it will be for neck pain and lumbar spine pain. However, if you have cleared the hips, feet and thoracic and there is still pain or dysfunction, you may want to drive motion through the lumbar more directly.
For this I use a Type I/Type II Motion Matrix specifically for the lumbar spine. This was something I picked up from Gary Gray and is absolute genius to be perfectly honest! As with all techniques it is knowing when to apply it appropriately – when it is appropriate it works brilliantly. As with all techniques I use, the exercises have to be performed pain free.
The lumbar spine seems to respond better to Type I Motion when it is in mid-range of sagittal motion, and Type II when it is in a relative end-range of either flexion or extension.
So here are my strategies. I use a step to help drive the sagittal and frontal plane motion and I use the step forward to drive the lumbar from the bottom up, and hand drivers to drive the sagittal and transverse plane. I also use a relatively heavy weight in the same side hand that is on the step. This helps drive the lumbar in the frontal plane from the top down. I told you it was genius!
Type I Motion
I start by asking my patient to stand on the step for this one as it drives the lumbar spine really well via the pelvis. To create the Type I motion at the lumbar, step off with the right leg. This anteriorly tilts, right tilts and left rotates the pelvis, causing extension, left lateral flexion and right rotation of the lumbar spine. However, because the anterior tilt creates a fair bit of extension, I would suggest driving the left hand into right rotation at around hip/knee height to create a little flexion to keep the lumbar spine in mid range.
To create the opposite Type I motion, you can simply reverse everything 🙂
Type II Motion
If you are trying to create Type II motion, right rotation and right lateral flexion. This time you step onto the step with your right leg. This gets you a posterior tilt, left tilt and left rotation of the pelvis, which gives you flexion, right rotation and right lateral flexion of the lumbar spine. Because this is Type II motion, I want to be towards end range so I usually drive the left hand into right rotation at knee height. This further flexes the spine and gives a top-down driver of right rotation, which complements the bottom-up driver. Again, I would use a weight in the hand that is on the step, so right hand this time. Again, reverse everything to create left Type II motion.
These exercises can be very gentle if you keep up the speed and the range down, and should always be pain free, but you can increase as the client is able. They are also a great way to assess which motions the person has trouble with. As you watch them go through each motion you can see if there is a limitation in any particular plane or with either Type I or Type II motion. Most people will prefer one or other of the motions, which gives you a great place to start when trying to improve lumbar spine motion.