Figure 1. The Dynamic Arthro-Myofascial Translation Test (DAMT-test). This figure displays the full DAMT-test procedure of L3 as an example of obtaining the trigger and tape direction for trunk flexion. Test: (1) First the patient underwent a baseline test to obtain the flexion and extension trunk range of motion and level of pain (pain NRS). Subsequently, the most painful spinal movement direction (highest pain NRS score) was used as a reference test to test the effect of displacing the skin and underlying fasciae (SKD) on the range of motion and level of pain. (2) The reference test was performed with ongoing mediolateral SKD to the left and right. The 3 tests (reference test including no SKD or left SKD or right SKD) were compared by the patient in choosing the best condition as the so-called ‘positive’ direction. (3) Trigger: The positive direction was the direction of the triggers, which started with softening the superficial fascia toward the deeper myofascia. (4) After softening the tissues, the tested spinal segment (eg, L3) was mobilized in the direction of the positive SKD test and in the directional preference. (5) Tape: Subsequently, the elastic tape was applied by rubbing the skin and fascia in the mediolateral positive direction. After the full procedure (steps 1 to 5), the steps were repeated for the next location (eg, from 1st step L3 to 2nd step S2) till the patient could move with an acceptable level of pain so the patient was able to perform the prescribed training. (Represented photos are from the 4xT book with permission of the author Karl Noten [24]).