Spine Health. PROCEDURE 11 — SUSTAINED ROTATION/MOBILISATION IN FLEXION

The patient lies supine on the couch, and the therapist stands on the side to which the legs are to be drawn, facing the head end of the couch. The patient’s far shoulder is held firmly on the couch by the therapist’s near hand, providing fixation and stabilisation. With the other hand the therapist flexes the patient’s hips and knees to a rightangle and carries them towards himself, causing the lumbar spine to rotate. With the patient’s ankles resting on the therapist’s thigh the knees are allowed to sink as far as possible and the legs are permitted to rest in that extreme position. The lumbar spine is now hanging on its ligaments in a position which combines side bending and rotation. By pushing the knees further towards the floor the therapist applies overpressure to take up the remaining slack in the lumbar spine. Depending on the purpose for which the procedure is used, the position of extreme rotation is maintained for a shorter or longer period.

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Fig. Sustained rotation/mobilisation in flexion.

Effects:

The procedure is mainly used in derangement. Sustained rotation for about thirty to forty seconds provides the time factor required to allow alteration of the position of the fluid nucleus within the disc. In those situations where time is important in the reduction this procedure may effect relief that will not be obtained by the much quicker performed rotation thrust (procedure 12). During the period that rotation is sustained the patient should be watched closely and asked constantly about the behaviour of pain. Any sign of peripheralisation of symptoms indicates that more than enough time has been spent in this position.

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The procedure may also be used as a mobilising technique in dysfunction, or as premanipulative testing in dysfunction as well as in derangement. In these cases the rotation is less sustained or performed in a rhythmical mobilising manner.

If a small therapist cannot reach across the patient to stabilise his shoulder, a seat belt fastened firmly across the patient’s upper chest provides adequate fixation. Alternatively, a second person may be used to hold the patient down.

TREATMENT OF SIDE GLIDING DYSFUNCTION — CORRECTION OF SECONDARY LATERAL SHIFT Having observed thousands of lumbar spines it has become clear to me that asymmetry is the ‘norm’ and symmetry is almost atypical. Therefore, when examining dysfunction patients it is important to realise that many exhibit a minor scoliosis or lateral shift, the direction of which is sometimes extremely difficult to determine. With careful observation it can be seen that the top half of the patient’s body is not correctly related to the bottom half, and the patient has shifted laterally about the lumbar area. The anomalies include a number of lateral shifts now dysfunctional in character. These lateral shifts are referred to as secondary whereas those caused by derangement are primary. Fig. Recovery of loss of side gliding, leaching the procedure of self-correction of secondary lateral shift. As discussed previously, we must determine whether the lateral shift is relevant to the present symptoms or is merely a congenital or developmental anomaly. If side gliding produces pain the...
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...
TREATMENT OF FLEXION DYSFUNCTION Loss of flexion is the second most common movement loss in the lumbar spine. It manifests itself in several ways, which interfere with either the amount of available flexion or the pathway taken to achieve flexion. This type of dysfunction is commonly seen in patients with an accentuated lordosis. Patients with significant flexion dysfunction are usually unable to sit slouched with a convex lumbar spine. When giving postural instructions to these patients, we must explain that once sitting relaxed they place the lumbar spine on full stretch much sooner than patients with a normal flexion excursion. Fig. Recovery of loss offlexion, using the procedure of flexion in standing. Recovery of pure flexion loss To regain flexion we must, just as in the case of extension dysfunction, explain to the patient the purpose of performing exercises. Again, we must stress the necessity of causing a moderate degree of discomfort or pain with the exercises. Pain produced by stretching of contra...
Spine Health. PROCEDURE 4 — EXTENSION IN LYING WITH BELT FIXATION The patient’s position and the exercise are the same as in the third procedure, but now a fixating belt is placed at or just below the segments to be extended. The safety belt is the first simple external aid, used to enhance maximum extension. It does so by preventing the pelvis and lumbar spine lifting from the couch. Other methods of restraint may be used effectively, for example the body weight of a young son or daughter when exercising at home. Fig. Extension in lying with belt fixation. Effects: This procedure creates a greater and more localised passive extension stress than the previous ones. It is particularly suitable for stretching in the case of extension dysfunction, and is more often required in dysfunction than in derangement. In dysfunction some pain will be experienced in the small of the back while exercising, because contracted tissues are being stretched. In derangement the rules pertaining to the centralisation phenomenon must be observed, and the proce...
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...