Double-thumb, segmental specific contact using the Versa-open belt

A cLBP patient with point tenderness at L3/L4 (very common with LB pain without leg referral) had been decompressed/prone over (4) sessions with only short-term relief (Laser was avoided due to a tattoo and previous Ultrasound was ineffective). The response to decompression was good but very short-term so we opted to add ‘manual-contact’ at the most painful segment. The tricky nature of painful segments is that ‘hypermobility’ may be the issue (McGill shear instability test) and thus a mobilization is unlikely the best treatment if long term relief is the goal (cavitation and mechanoreceptor affects likely giving the temporary relief…and if L5 is hypermobile but you want to move L4…the cavitation is still more likely to occur at L5). The advantage of an axial pull with a harness is that it frees up both of the clinicians hands (in this case thumbs) for direct, segmental specific manual treatment. The contact is I-S and the amount of pressure in other planes of motion is to the doctors’ discretion. I found more right-sided pressure gave immediate benefit and after 2 (8) second pulls there was a loud cavitation ‘apparently’ at the L3 level, after (4) manual-contact sessions the patient improved markedly and began low-tech rehab.