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Femoral root flossing

This is an excerpt from Low Back Disorders 4th Edition With HKPropel Access by Stuart McGill.

The patient lies prone, with the head and neck sufficiently extended past the end of the table to fully flex the neck unimpeded (figure 10.6). Fully flex the patient’s cervical spine. Lift the patient’s head into full cervical extension while at the same time bringing the heel toward the buttock, flossing the femoral root. The patient may find that turning the head one way or the other eliminates pain (or at least expands the pain-free range). Reaching the patient’s arm over the head and pulling the nerve train and fascia cranially may also eliminate pain. Try eight repetitions per leg, then five repetitions with both legs, and evaluate if this dose was appropriate. Note that moving both legs together increases the nerve excursions.

Figure 10.6 (a) The patient begins prone with the cervical spine fully flexed. (b) The cervical spine is extended in a coordinated fashion with one knee flexing and lowered. (c) As an option, both legs may be moved together for a few final reps.
Figure 10.6 (a) The patient begins prone with the cervical spine fully flexed. (b) The cervical spine is extended in a coordinated fashion with one knee flexing and lowered. (c) As an option, both legs may be moved together for a few final reps.

TECHNIQUE TIPS

  • To enhance efficacy, first have the patient adopt a posture that relieves impingement. For example, a patient with a disc bulge who can reduce the bulge by adopting a prone extension posture (such as shown in the McKenzie-posture test in chapter 9) should do so for a few minutes before flossing. The patient should then adopt the posture with the longest reflex response.
  • To create floss rather than length change in the neural tract, the motion should be slow (with a flexion–extension cycle lasting about 5 seconds), but most importantly, it should be coordinated.
  • The objective is to create motion rather than a static stretch. The patient should not push into the end range, and the motion should never travel into a painful range.
  • The patient should begin by performing 10 repetitions with each leg. If his symptoms are not exacerbated, he can perform these repetitions several times per day. The patient should not perform flossing within the first 2 hours after rising from bed.

ADVANCED FLOSSING

Professor Olavi Airaksinen and colleagues in Finland (personal communication, June 2013) found that double-leg flossing increased the central neural tract excursion distance and may be considered as an exercise to be added to the routine (see figure 10.7). The progression continues in a side-lying position; the hip joint becomes involved in creating large nerve excursions.

If the radiating symptoms more often occur in bed, consider the pain pathway. If the pain is from a disc bulge contacting a nerve, the patient should try some decompression before lying down, such as lying on the belly to reduce the bulge, followed by a few bird dog repetitions and then the nerve floss. In addition, a PropAIR support can be used to align the spine and reduce the bulge pressure or align a micromovement (should that be the cause of the nerve contact).

Figure 10.7 (a,b) Both legs are moved in unison to increase the nerve floss excursion. (c,d,e) The progression may continue in side-lying where the neck is flexed while the hip and knee are extended, and the ankle is plantar flexed. The cycle is completed with the opposite movement.
Figure 10.7 (a,b) Both legs are moved in unison to increase the nerve floss excursion. (c,d,e) The progression may continue in side-lying where the neck is flexed while the hip and knee are extended, and the ankle is plantar flexed. The cycle is completed with the opposite movement.

We may suggest progressing to giant swings and the body saw if a stable environment increases the patient’s tolerance to perform the drill (figure 10.8 and video).

Figure 10.8 (a,b) The patient stands on one leg while holding a steady anchor with the opposite hand. As the cervical spine flexes, the knee is flexed and the ankle plantar flexed. Then the opposite occurs with cervical spine extension, hip flexion, knee extension, and ankle dorsiflexion. (c,d) The body saw is a variation with shoulder and ankle motion while the torso is stabilized in a plank position. This helps some people begin flossing without symptoms.
Figure 10.8 (a,b) The patient stands on one leg while holding a steady anchor with the opposite hand. As the cervical spine flexes, the knee is flexed and the ankle plantar flexed. Then the opposite occurs with cervical spine extension, hip flexion, knee extension, and ankle dorsiflexion. (c,d) The body saw is a variation with shoulder and ankle motion while the torso is stabilized in a plank position. This helps some people begin flossing without symptoms.
More Excerpts From Low Back Disorders 4th Edition With HKPropel Access

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