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:

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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.

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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.

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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...
Spine Health. PROCEDURE 13 — FLEXION IN LYING The patient lies supine with the knees and hips flexed to about forty-five degrees and the feet flat on the couch. He bends the knees up towards the chest, firmly clasps the hands about them and applies overpressure to achieve maximum stress. The knees are then released and the feet placed back on the couch. The sequence is repeated about ten times. The first two or three flexion stresses are applied cautiously, but when the procedure is found to be safe the remaining pressures may become successively stronger, the last two or three being applied to the maximum possible. Fig. Flexion in lying. Effects: Flexion in lying causes a stretching of the posterior wall of the annulus, the posterior longitudinal ligament, the capsules of the facet joints, and other soft tissues. As the movement takes place from below upwards the lower lumbar and lumbo-sacral joints are placed on full stretch at the beginning of the exercise as soon as movement is initiated. Thus, the procedure is very i...
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