The neutral position of the spine was used for side-posture lumbar manipulation. The patient lay on the asymptomatic side (e.g. left) in the lateral recumbent position, with his or her upper foot in the popliteal fossa of the lower leg. Standing opposite to the patient, the therapist grasped the patient’s lower shoulder and arm and applied right rotation until motion was felt in the desired segment of the lumbar spine. The patient was rolled toward the therapist, with his or her arms positioned around the therapist’s right arm. The therapist’s right forearm was in contact with the patient’s right axilla and pectoral region to maintain appropriate rotation from above. In this position, the therapist applied a high-velocity low-amplitude thrust to the pelvis in an anterior direction with his or her left forearm placed behind the patient’s right hip. The therapist pressed the spinous process of the upper vertebra downward with his or her right thumb, while pulling the spinous process of the lower vertebra upward with his or her left thumb. The procedure was done in a way that avoided exacerbating the patient’s pain at the barrier point  (Fig. 1).Fig. 1Lumbar rotation manipulation