Spine Health. PROCEDURE 10 — ROTATION MANIPULATION IN EXTENSION

The patient lies prone as for procedure 1. The therapist stands to one side of the patient and, having selected the correct segment, places the hands on either side of the spine as for the technique of rotation mobilisation in extension (procedure 9), which is always applied as a premanipulative testing procedure.

The information obtained from the mobilisation is vital and determines on which side and in which direction the manipulation is to be performed. If following testing the manipulation is indicated, the therapist reinforces the one hand with the other on the appropriate transverse process. The manipulation is then performed as in procedure 8.

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Fig. Rotation manipulation in extension.

Effects:

The effects of the external force and the reasons for its use are the same as for procedure 9. When the desired result is not obtained with the mobilising technique, manipulation is indicated under certain circumstances. Regarding the direction in which the manipulation is to be performed the same rules apply as for procedure 9.

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 p...
Examination of Back Pain Having digested the information supplied by the referring doctor, extracted as much relevant information as possible from the patient, and checked the radiologist’s report, we may proceed to the examination proper. If the patient is able to do so, we should make him sit on a straight backed chair while taking his history. During this lime he will reveal the true nature of his sitting posture. When the patient rises to undress after the interrogation we should observe the way he rises from sitting, his gait, the way he moves, and any deformity that may be obvious. We will record the following: I. POSTURE SITTING If the patient has been sitting during history taking, we already have a good impression of his posture. We now ask him to sit on the edge of the examination table with his back unsupported. In the majority of cases the patient will sit slouched with a flexed lumbar spine. Some patients are more aware of the relationship between their posture and pain. They have discover...
Spine Health. PROCEDURE 12 — ROTATION MANIPULATION IN FLEXION The sequence of procedure 11 must be followed completely to perform the required pre-manipulative testing. If the manipulation is indicated a sudden thrust of high velocity and small amplitude is performed, moving the spine into extreme side bending and rotation. Fig. Rotation manipulation in flexion. Effects: There are many techniques devised for rotation manipulation of the lumbar spine. When rotation of the lumbar spine is achieved by using the legs of the patient as a lever or fulcrum of movement, confusion arises as to the direction in which the lumbar spine rotates. This is judged by the movement of the upper vertebrae in relation to the lower — for example, if the patient is lying supine and the legs are taken to the right, then the lumbar spine rotates to the left. It has become widely accepted that rotation manipulation of the spine should be performed by rotation away from the painful side. This has applied to derangement as well as dysfunction, because hitherto n...
EFFECTIVE PAIN MANAGEMENT According to the Agency for Healthcare Research and Quality (AHRQ), a federal agency established in 1989, there are three major barriers to effective pain management: the health-care system health-care professionals clients The health-care system is slow to hold itself accountable for assessing and relieving pain. Many professionals suggest that assessment of pain be included with the measurement of taking vital signs, such as temrerature, pulse, respiration, and blood pressure. Pain assessment would be the fifth vital sign. It is helpful to remember that heart rate and blood pressure may increase with acute pain but not necessarily with chronic pain. The belief is that routinely assessing and relieving pain would prove more cost effective than ignoring the issue. Health professionals are not always educated about the meaning of and assessment of pain management and may be concerned about the use of opioids (narcotics), mainly due to possible addiction. Clients and their fam...
Spine Health. PROCEDURE 9 — ROTATION MOBILISATION IN EXTENSION The position of patient and therapist is the same as for procedure 7. By modifying the technique of extension mobilisation so that the pressure is applied first to the transverse process on the one side and then on the other side of the appropriate segment a rocking effect is obtained. Each time the vertebra is rotated away from the side to which the pressure is applied — for example, pressure on the right transverse process of the fourth lumbar vertebra causes left rotation of the same vertebra. The technique should be repeated about ten times on the involved segment and, if indicated, adjacent segments should be treated as well. Fig. Rotation mobilisation in extension. Effects: Also here the external force applied by the therapist enhances the effects on derangement and dysfunction as described for the previous extension procedures. The reasons for adding therapist-technique are the same as for procedure 7. In general, unilateral techniques are likely to effect unilateral...