Back pain Prevention

The majority of patients responding to basic extension and flexion principles of treatment have been educated in the means of achieving pain relief and restoring function. They have carried out the self-treatment procedures and have to a large extent become independent of therapists. Following successful treatment it requires little emphasis to convince patients that if they were able to reduce and abolish pain already present, it should also be possible to prevent the onset of any significant future low back pain.

Of all the factors predisposing to low back pain only postural stresses can be easily influenced and fully controlled. We must develop this potential ingredient of prophylaxis to the full. The patient must understand that the risks of incurring low back pain are particularly great when the lumbar spine is held in sustained flexed positions; and that when the lordosis is reduced or eliminated for prolonged periods, he must at regular intervals and before the onset of pain make a conscious effort to interrupt flexion, restore the lordosis and accentuate it momentarily to the maximum. It is essential that the patient knows the reasons for doing this, and therefore we must explain to him in lay terms that on restoring the lordosis the intradiscal pressure decreases, the nuclear fluid moves anteriorly and the posterior stresses in and around the disc are reduced.

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Briefly summarised, the following prophylactic measures should always be taken:

  • Prolonged sitting requires (a) maintenance of the lordosis by muscular control of the posture or, preferably, by insertion of a lumbar roll, (b) hourly interruption of sitting by standing up, walking around for a few minutes and accentuating the lordosis by a few repetitions of extension in standing (Proc. 6).
  • Activities involving prolonged stooping require (a) interruption of stooping at regular intervals by standing upright, (b) regularly reversing the curvature of the lumbar spine, restoring and accentuating the lordosis by a few repetitions of extension in standing (Proc. 6).
  • Lifting requires (a) the use of the correct lifting technique. Generally, if the object to be lifted exceeds fifteen kilograms, the strain must be taken with the lumbar spine in lordosis and the lift must be performed using the legs. If the object to be lifted weighs under fifteen kilograms less care is necessary, unless one has been in a bent or sitting position for some time prior to the lift. In the latter case the same rules apply as for lifting weights exceeding fifteen kilograms, (b) accentuation of the lordosis before and after lifting by a few repetitions of extension in standing (Proc. 6).
  • If inadvertently pain has developed during sitting, stooping or lifting, the patient should immediately commence extension in lying (Proc. 3).
  • Extension in standing (Proc. 6), very effective in preventing the onset of pain, is less effective when used to reduce present pain. Extension in lying (Proc. 3) is the technique of first aid for back pain.
  • Recurrence: At the first sign of recurrence the patient should immediately commence the procedures which previously led to recovery. Although an episode of low back pain can commence suddenly and without warning, many patients are aware of a minor degree of discomfort before the onset of severe pain. If this type of warning is given, the patient has an excellent chance to prevent the development of symptoms, provided the appropriate procedure is applied immediately.
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It is not possible for patients to remember all verbal instructions and advice given during the first treatment. To avoid tedious repetition and to ensure the necessary information is conveyed to the patient, a list of instructions is supplied on the first visit. This list firstly deals with information for patients in the acute stage of low back pain, and secondly provides information required once recovery has taken place. These instructions form an important part of self-treatment, because when followed properly they will help in reduction of present symptoms and prevention of their recurrence.

Spine Health. PROCEDURE 8 — EXTENSION MANIPULATION There are many techniques devised for manipulation of the lumbar spine in extension. It is not important which technique is used, provided the technique is performed on the properly selected patient and applied in the correct direction. The technique that I recommend is similar to the first two manipulations described by Cyriax for the reduction of a lumbar disc lesion. The patient lies prone as for procedure 1. The therapist stands to one side of the patient and, having selected the affected segment, places the hands on either side of the spine as for the technique of extension mobilisation (procedure 7), which is always applied as a premanipulative testing procedure. If following testing the manipulation is indicated, the therapist leans over the patient with the arms at right angles to the spine and forces slowly downwards until the spine feels taut. Then a high velocity thrust of very short amplitude is applied and immediately released. Fig. Extension manipulation. The eff...
Deformities of the spine: Lordosis, Kyphosis, and Scoliosis ICD-9: 737.20 LORDOSIS ICD-9: 737.10 KYPHOSIS ICD-9: 737.30 SCOLIOSIS Video: How to Correct a Scoliosis With Exercise and Stretching Description ⚡ Lordosis ⚡ is an abnormal inward curvature of the lumbar or lower spine. This condition is commonly called “swayback.” Kyphosis is an abnormal outward curvature of the upper thoracic vertebrae. Commonly, this curvature is known as “humpback” or “round back.” Scoliosis is an abnormal sideward curvature of the spine to either the left or right. Some rotation of a portion of the vertebral column also may occur. Scoliosis often occurs in combination with kyphosis and lordosis. These three spinal deformities may affect children as well as adults. FIGURE. Spinal curvatures Etiology Lordosis, kyphosis, and scoliosis may be caused by a variety of problems, including congenital spinal defects, poor posture, a discrepancy in leg lengths (especially in scoliosis), and growth retardation or a vascular disturbance in the epiphysis of th...
TREATMENT OF THE DERANGEMENT SYNDROME Of all patients with low back pain those having derangement of the intervertebral disc are the most interesting and rewarding to treat. As in dysfunction, it is essential in derangement that from the very first treatment correction of the sitting posture be achieved, but in the early and acute stages of derangement emphasis is placed on the maintenance of lordosis rather than the obtaining of the correct posture. Failure in this respect means failure of what otherwise might be a successful reduction of the derangement. So often it occurs that a patient describes a significant relief from pain and is visibly improved immediately following treatment, but later that same day after sitting for some time he is unable to straighten up on rising from sitting and the symptoms have returned just as they were before treatment. Usually the patient clearly understands the dangers of bending and stooping and carefully avoids these movements. But the hidden dangers of sustained flexion incurred in t...
The Dysfunction Syndrome The word ‘dysfunction’ chosen by Mennell to describe the loss of movement commonly known as ‘joint play’ or ‘accessory movement’ seems infinitely preferable to the terms ‘osteopathic lesion’ and ‘chiropractic subluxation’, neither of which means anything and both of which mean everything. ‘Dysfunction’ or ‘not functioning correctly’ at least acknowledges that something is wrong without going through the sham procedure of pretending that only those who belong to the club really understand the terminology. For years osteopaths and chiropractors have claimed that only the people, properly trained in their particular calling, have the necessary knowledge to understand their terminology. There may be some truth in that. Although I believe that the term ‘dysfunction’ as used by Mennel does not strictly cover the loss of movement caused by adaptive shortening, I have chosen to use this term instead of repeatedly referring to ‘adaptive shortening’. Essentially, the mechanism of pain prod...
Acute Low Back Pain. General Instructions You must retain the lordosis at all times (lordosis is the hollow in the lower back). Bending forwards as in touching the toes will only stretch and weaken the supporting structures of the back and lead to further injury. Losing the lordosis when sitting will also cause further strain. SITTING When in acute pain you should sit as little as possible, and then only for short periods only. At all times you must sit with a lordosis. Therefore you must place a supportive roll in the small of the back, especially when sitting in a car or lounge chair. If you have the choice you must sit on a firm, high chair with a straight back such as a kitchen chair. You should avoid sitting on a low, soft couch with a deep seat; this will force you to sit with hips lower than knees, and you will round the back and lose the lordosis. The legs must never be kept straight out in front as in sitting in bed, in the bath or on the floor; in this position you are forced to lose the lordosis. W...