Spine Health. PROCEDURE 14 — FLEXION IN STANDING

The simple toe touching exercise in standing does not need much elaboration. The patient, standing with the feet about thirty centimeters apart, bends forward sliding the hands down the front of the legs in order to have some support and to measure the degree of flexion achieved. On reaching the maximum flexion allowed by pain or range, the patient returns to the upright position. The sequence is repeated about ten times, should be performed rhythmically, and initially with caution and without vigour. It is important to ensure that in between each movement the patient returns to neutral standing.

Fig. Flexion in standing.

Effects:

READ:   Spine Health. PROCEDURE 5 — SUSTAINED EXTENSION

Flexion in standing differs from flexion in lying in various ways. Naturally, the gravitational and compressive forces act differently in both situations. In flexion in standing the movement takes place from above downwards, and the lower lumbar and lumbo-sacral joints are placed on full stretch only at the end of the movement. In addition, the lumbo-sacral nerve roots are pulled through the intervertebral foramina.

Thus, flexion in standing can be used as a progression of flexion in lying and may affect dysfunction as well as derangement. It can also be used specifically to stretch the scarring in an adherent nerve root or in nerve root entrapment.

READ:   Spine Health. PROCEDURE 15 — FLEXION IN STEP STANDING

If, in attempts to recover function following derangement, flexion in standing is performed too soon, the patient may rapidly worsen. This will happen even when there is no nerve root involvement. The same patient may safely perform flexion in lying and experience no increase in pain. It would appear that the gravitational stresses during flexion in standing are sufficient to cause an increase in derangement by further bulging of the disc wall.

Flexion in standing is an important procedure in the treatment of anterior derangement situations (Derangement Seven), as it causes a posterior movement of the nucleus within the disc wall.

READ:   PAIN AND ITS TREATMENT MODELS
Spine Health. PROCEDURE 3 — EXTENSION IN LYING The patient, already lying prone, places the hands (palms down) near the shoulders as for the traditional press-up exercise. He now presses the top half of his body up by straightening the arms, while the bottom half, from the pelvis down is allowed to sag with gravity. The top half of the body is then lowered and the exercise is repeated about ten times. The first two or three movements should be carried out with some caution, but once these are found to be safe the remaining extension stresses may become successively stronger until the last movement is made to the maximum possible extension range. If the first series of exercises appears beneficial, then a second series may be indicated. More vigour can be applied and a better effect will be obtained if the last two or three extension stresses are sustained for a few seconds. It is essential to obtain the maximum elevation by the tenth excursion and once obtained the lumbar spine should be permitted to relax into the most extreme ...
Back pain. Predisposing and Precipitating Factors PREDISPOSING FACTORS Sitting posture There are three predisposing factors in the etiology of low back pain that overshadow most others. The first and most important factor is the sitting posture. A good sitting posture maintains the spinal curves normally present in the erect standing position. Postures which reduce or accentuate the normal curves enough to place the ligamentous structures under full stretch will eventually be productive of pain. Such postures are referred to as poor sitting postures. A poor sitting posture may produce back pain in itself without any additional other strains of living. We have all seen patients who entered an airliner, a car, or even a common lounge chair in a perfectly healthy and painfree state only to emerge hours later crippled with pain and unable to walk upright. Alternatively, a poor sitting posture will frequently enhance and always perpetuate the problems in patients suffering from low back pain. By far the great majority of patients comp...
TREATMENT OF THE POSTURAL SYNDROME Every patient must be examined and analysed individually, and educated for his own particular postural stress. Education is probably the most important part of the treatment for low back pain of postural origin. The patient must have a clear and unambiguous explanation of the mechanism that produces his pain. He must realise that, when he assumes the positions of stress causing pain, he is in fact pulling the ligaments apart; and all that is required to stop his postural pain, is to stop stressing the ligaments for about ten days. I also explain to the patient that once he commences the correction regime, he will and should develop some new pains which are commonly felt higher in the back. This is merely the consequence of adjustment to a new postural habit. The more often pain is triggered, the more readily it will occur. And the less often pain is triggered, the more difficult it is to be produced. Thus, poor sitting positions maintained regularly will cause pain after the passage...
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...
GATE CONTROL THEORY OF PAIN What occurs at the cellular level when pain is experienced? The gate control theory of pain, by P. D. Wall and Ronald Melzack, offers a useful model of the physiological process of pain. Gate control is recognized as a major pain theory. According to the gate control theory, pain is a balance between information traveling into the spinal cord through large nerve fibers and information traveling into the spinal cord through small nerve fibers. Without any stimulation, both the large and small nerve fibers are quiet, and the substantia gelatinosa (SG) blocks the signal to the transmission cell (T cell) connected to the brain. The “gate is closed,” and there is no pain. With pain stimulation, small nerve fibers are active. They activate the T-cell neurons but block the SG neuron, making it impossible for the SG to block the T-cell transmission to the brain. The result is that the “gate is open”; therefore, there is pain. In other words, pain is experienced whenever the substances that ...