Spine Health. PROCEDURE 15 — FLEXION IN STEP STANDING

In this procedure the patient stands on one leg while the other leg rests with the foot on a stool so that hip and knee are about ninety degrees flexed. Keeping the weight bearing leg straight the patient draws himself into a flexed position, firmly approximating the shoulder and the already raised knee (both being on the same side). If possible the shoulder should be moved even lower than the knee. The patient may apply further pressure by pulling on the ankle of the raised foot. The pressure is then released and the patient returns to the upright position. The sequence is repeated about six to ten times. It is important that the patient returns to neutral standing and restores the lordosis in between each movement.

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Fig. Flexion in step standing.

Effects:

This procedure causes an asymmetrical flexion stress on the affected segments. It is applied when there is a deviation in flexion, which may occur in dysfunction as well as derangement. Both in dysfunction and derangement the leg to be raised is that opposite to the side to which the deviation in flexion is taking place — for example, in deviation in flexion to the left the right leg has to be raised.

In dysfunction asymmetrically shortened structures are stretched by flexion in step standing, provided it is performed often enough with the application of sufficient stress.

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In derangement the procedure will influence the off-center nucleus so that it moves to a more central position, thus allowing the normal pathway of flexion to be regained. Where deviation in flexion is due to derangement some patients will experience a reversal of the deviation if the procedure is performed too often. Thus the exercise must be repeated only five to six times before checking if flexion in standing has been reduced to normal.

Back Pain. Diagnosis THE THERAPIST’S RESPONSIBILITY The therapist is part of the team involved in the treatment and rehabilitation of patients suffering low back pain. In some countries manipulative therapists are primary contact practitioners. Consequently, their diagnostic skills have greatly improved, enabling them to define which mechanical conditions can be helped by mechanical therapy and to separate these conditions from the nonmechanical lesions which have no place in the therapy clinic. However, differential diagnosis is really not within the scope of manipulative therapy. It is my view that differential diagnosing by medical practitioners is necessary to exclude serious and unsuitable pathologies from being referred for mechanical therapy. In making diagnoses the manipulative therapist should confine himself to musculo-skeletal mechanical lesions. Specialised in this field, he is usually able to make far more accurate diagnoses than most medical practitioners. As the manipulative therapy prof...
Spine Health. PROCEDURE 7 — EXTENSION MOBILISATION The patient lies prone as for procedure 1. The therapist stands to one side of the patient, crosses the arms and places the heels of the hands on the transverse processes of the appropriate lumbar segment. A gentle pressure is applied symmetrically and immediately released, but the hands must not lose contact. This is repeated rhythmically to the same segment about ten times. Each pressure is a little stronger than the previous one, depending on the patient’s tolerance and the behaviour of the pain. The procedure should be applied to the adjacent segments, one at a time, until all the areas affected have been mobilised. Fig. Positioning of hands prior to extension mobilisation. Extension mobilisation. Effects: In this procedure the external force applied by the therapist enhances the effects on derangement and dysfunction as described for the previous extension procedures. In general, symmetrical pressures are used on patients with central and bilateral symptoms. Therapist-...
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 1 — LYING PRONE The patient adopts the prone lying position with the arms alongside the trunk and the head turned to one side. In this position the lumbar spine falls automatically into some degree of lordosis. Fig. Lying prone. Effects In derangement with some degree of posterior displacement of the nuclear content of the disc the adoption of procedure 1 may cause, or contribute to, the reduction of the derangement provided enough time is allowed for the fluid nucleus to alter its position anteriorly. A period of five to ten minutes of relaxed prone lying is usually sufficient. This procedure is essential and the first step to be taken in the treatment and self-treatment of derangement. In patients with a major derangement, such as those presenting with an acute lumbar kyphosis, the natural lordosis of prone lying is unobtainable. These patients cannot tolerate the prone position unless they are lying over a few pillows, supporting their deformity in kyphosis. In minor derangement situat...
TREATMENT OF PAIN The objective of pain treatment is to remove or correct the cause of pain or to lessen the severity of the pain; however, there can be a lag in time between identifying the cause of the pain and providing relief. The treatment of pain is diverse and can be difficult. A multidisciplinary approach to chronic pain management is often most successful but is not always available to everyone. This team approach involves both medical and nonmedical personnel and may include any of a number of approaches. There also are a number of integrative/complementary pain control protocols that may be effective. Treatment of pain depends on the type of pain. Medications, also, are different in their pain control management. Medications Medications tend to be the treatment of choice for many clients experiencing pain. Analgesics, anesthetics, and anti-inflammatory agents may be prescribed to decrease or eliminate pain, although they do not eliminate the cause of pain. Analgesics can be opioid (formerly...