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.

READ:   Intervertebral discs

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.

READ:   Back Pain. Diagnosis

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.

The Intervertebral Disc STRUCTURE In the lumbar spine the intervertebral discs are constructed similarly to those in other parts of the vertebral column. The disc has two distinct components: the annulus fibrosus forming the retaining wall for the nucleus pulposus. The annulus fibrosus is constructed of concentric layers of collagen fibres. Each layer lies at an angle to its neighbour and the whole forms a laminated band which holds the two adjacent vertebrae together and retains the nuclear gel. The annulus is attached firmly to the vertebral end plates above and below, except posteriorly where the peripheral attachment of the annulus is not so firm. Moreover, the posterior longitudinal ligament with which the posterior annulus blends is a relatively weak structure, whereas anteriorly the annulus blends intimately with the powerful anterior longitudinal ligament. The posterior part of the annulus is the weakest part: the anterior and lateral portions are approximately twice as thick as the posterior port...
Spine Health. PROCEDURE 5 — SUSTAINED EXTENSION To apply a sustained extension stress to the lumbar spine an adjustable couch, one end of which may be raised, is a necessary piece of equipment. The patient lies prone with his head at the adjustable end of the couch which is gradually raised, about one to two inches at the time over a five to ten minute period. Once the maximum possible degree of extension is reached, the position may be held for two to ten minutes, according to the patient’s tolerance. When lowering the patient the adjustable end of the couch should slowly be returned to the horizontal over a period of two to three minutes. This must not be done rapidly, for acute low back pain may result. Fig. Sustained extension. Effects: The procedure is predominantly used in the treatment of derangement. The effect is similar to that of the third procedure, but a time factor is added with the graduated increase and the sustained nature of the extension. In certain circumstances a sustained extension stress is preferable...
Spinal manipulation techniques There are many differing philosophies and concepts surrounding the practise of spinal manipulation and its effects on the pathologies which may exist in the spine. To satisfy all these philosophies an equal number of institutions has developed, teaching those wishing to learn. No matter what school presents its case or which philosophy is adhered to, all manipulative specialists claim to have a high success rate. They all use techniques which vary in nature, application and intent; they proclaim that their own methods are superior to those used by others; and yet, somehow they all obtain uniformly good results. Self-limitation of low back pain plays, of course, a significant role in this happy situation. Apart from this there are definite benefits which are obtained quickly by using manipulative techniques. Throughout the years I have practised many forms of mobilisation and manipulation, including osteopathic and chiropractic techniques and those taught by Cyriax. I have come to be...
TYPICAL TREATMENT PROGRESSION — THE DYSFUNCTION SYNDROME Day one Assessment and conclusion/diagnosis. Explanation of the cause of dysfunction and the treatment approach. Postural correction and instructions, especially regarding sitting; demonstrate the use of a lumbar support. Commence with exercises to recover function — that is, extension in lying, flexion in lying, or side gliding in standing, whatever procedure is indicated. Emphasise the need to experience some discomfort during the exercises, and the importance of frequent exercising during the day. If flexion in lying is recommended, we must warn to stop exercising if the symptoms quickly worsen. We may have overlooked derangement, or commenced the procedure too early following recent derangement. Always follow flexion exercises with some extension. Day two Confirm diagnosis. Check postural correction. Completely repeat'postural correction and instructions. Check exercises. If improving nothing should be changed. If not improving, ensure tha...
Kyphosis: Causes, Symptoms and Diagnosis What Causes Kyphosis? Kyphosis, also known as roundback or hunchback, is a condition in which the spine in the upper back has an excessive curvature. The upper back, or thoracic region of the spine, is supposed to have a slight natural curve. The spine naturally curves in the neck, upper back, and lower back to help absorb shock and support the weight of the head. Kyphosis occurs when this natural arch is larger than normal. If you have kyphosis, you may have a visible hump on your upper back. From the side, your upper back may be noticeably rounded or protruding. In addition, people with hunchback appear to be slouching and have noticeable rounding of the shoulders. Kyphosis can lead to excess pressure on the spine, causing pain. It may also cause breathing difficulties due to pressure put on the lungs. Kyphosis in elderly women is known as dowager’s hump. Common causes of kyphosis Kyphosis can affect people of any age. It rarely occurs in newborns because it’s usually caused...