Non-Neutral (Type II) Vertebral Somatic Dysfunction

The specific dysfunction is labeled by the position the zygapophyseal joint is stuck in and the asymmetrical position the segment assumes when it is moved in the direction of restricted motion. The three-dimensional motion restricted at the vertebral segment is diagonally opposite to the diagnostic label given to the dysfunction. There are four potential positional diagnoses for single quadrant limitations of segmental motion: ERSR, ERSL, FRSR and FRSL. These diagnoses are based upon osteopathic terminology and are commonly used in muscle energy and joint mobilization systems of treatment.

ERSL - Extended, Rotated and Side bent to the Left

This term describes the asymmetrical movement of the superior vertebra during flexion of the segment if the left zygapophyseal joint is unable to open (the inferior articular process of the superior vertebra is unable to glide superior on the superior process of the inferior vertebra). If the left zygapophyseal joint is stuck in a closed or extended position (it can not flex), the superior vertebra will side bend to the left as the segment is flexed. In accordance with Law II, the superior vertebra will also rotate to the left. The left rotation of the superior vertebra will cause its left transverse process to move posterior in relation to the right transverse process and the left transverse process below. The posterior position of the left transverse process of the superior vertebra can be palpated with the patient in a flexed spinal posture. When a zygapophyseal joint is unable to open with flexion, the posterior transverse process will be on the same side as the zygapophyseal joint that is stuck. The positional diagnosis would indicate that the superior vertebra is Extended, Rotated and Side bent to the Left. This dysfunction at the L3/4 segment would be recorded as L3 ERSL. The restricted motion at the segment is Flexion, Rotation and Side bending to the Right. If using a direct treatment technique like muscle energy, the motion restricted will be the three-dimensional direction the dysfunctional segment is moved toward during treatment.
Posterior view
Superior view