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Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 99 4 5 Kemp's Test: The therapist asks the client to right rotate, right sidebend, and extend his torso. The therapist places both hands on the client's shoulder and gently depresses. Record as a positive if this maneuver reproduces or enhances the client's symptoms. However, if the pain follows a dermatomal pathway into the lower extremity, it may indicate sciatic nerve root compression. Passive Sidebending Technique: With his right hand bracing the client's thigh, the therapist's left hand sidebends the client's lumbar spine to stretch the quadratus lumborum and decompress the Z-joints on the client's right side. The client is asked to gently right sidebend against the therapist's resistance to a count of five and relax, and the therapist again left sidebends the client to the next restrictive barrier. Repeat 3–5 times and retest using the Kemp's Test. Watch "Pelvic & Low Back Tests" RESTORING Z-JOINT MOBILITY Numerous studies have examined conservative care for people with low-back pain, but I'm unaware of any published investigations that have targeted Z-joint pain specifically. Nevertheless, most experts agree that the general principles of conservative treatment for nonspecific low- back pain can be applied to Z-joint pain too. 1 I've had reasonable success treating both acute and chronic cases of Z-joint pain using the Myoskeletal Alignment Techniques (MAT) demonstrated in Images 5 and 6. These graded-exposure stretching maneuvers are designed to bring balance to musculofascial tissues that torsion the pelvic bowl and create excessive anterior pelvic tilt. When performing these dynamic postural stretching routines, it is best to address all connective tissues that articulate with the lumbar spine, hips, and legs that may be creating abnormal compressive loading through arthritic Z-joints. In short, MAT treatment goals for Z-joint pain include: • Educating the client by explaining their pain in a reassuring manner that avoids catastrophizing • Reducing excessive lumbar lordosis • Restoring lumbar spine mobility, pelvic alignment, and pain-free movement • Providing (playful) self-care advice to strengthen and stabilize the lumbopelvis SUMMARY During each therapy session, feel free to offer advice about various sitting and standing postures that may help relieve compressive stress through the Z-joints. Cueing the client about faulty movement patterns helps bring the brain's attention to protectively guarded areas. All movements are governed by the central nervous system, so the brain will limit flexibility, range of motion, and mobility if it feels there is a potential danger. Therefore, it's important to always maintain good communication with clients and keep them actively engaged in the therapy process. While Z-joint arthritis can't be dramatically reversed, I've found that exercise, lifestyle changes, and proper bodywork can contribute to a better quality of life and less discomfort. Note 1. David S. Binder and Devi E. Nampiaparampil, "The Provocative Lumbar Facet Joint," Current Reviews in Musculoskeletal Medicine 2, no. 1 (March 2009): 15–24, https://doi.org/10.1007/s12178-008-9039-y. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com. 6 Iliosacral Alignment Technique: The therapist's left hand lifts the client's left anteriorly/inferiorly rotated ilium and his right palm braces the right posterior superior iliac spine. The therapist gently pulls with his left hand while resisting with his right. The client is asked to gently push his left ilium toward the table to a count of five and relax. The therapist rotates the client's pelvis to the next restrictive barrier to restore Z-joint alignment.