Having corrected the lateral shift and the blockage to extension, it is now essential to teach the patient to perform self-correction by side gliding in standing followed by extension in standing. This must be done on the very first day, so that the patient is equipped with a means of reducing the derangement himself at first sign of regression. Failure to teach self-correction will lead to recurrence within hours, ruining the initial reduction, and the patient will return the next day with the same deformity as on his first visit.

I have discarded the technique of self-correction as described previously and instead I now teach patients to respond to pressures applied laterally against shoulder and pelvis. Initially, therapist’ assistance is required. Patient and therapist stand facing each other. The therapist places one hand on the patient’s shoulder on the side to which he deviates, and the other hand on the patient’s opposite iliac crest. The therapist applies pressure by squeezing the patient between his hands, ensuring that the patient’s shoulders remain parallel to the ground. When over correction has been achieved by the therapist, the mobility must be maintained by the patient who is therefore taught to actively respond to the pressures applied by the therapist. After some practise, remembering to keep the shoulders parallel to the ground, the heels on the ground and the knees straight, the patient can correct his own deformity. It is important to make the patient stand for a minute or two in the extreme over corrected position.

READ:   Back Pain. Diagnosis

Immediately following correction of the lateral deformity full extension must be restored. In the corrected standing position the patient must perform about ten repetitions of extension in standing.

Fig. Self-correct ion of lateral shift.

It must be emphasised that as long as the lordosis is retained there is little chance of recurrence of the derangement. If the patient is unable to maintain the reduction, he must perform self-correction during the day at regular intervals. The patient is advised to perform a series of extension in lying exercises after each session of self-correction.

Effects and points to note:

It must be obvious that the last two procedures mainly influence the disc in derangement situations. In all instances time must be allowed for the reduction of the derangement to take place. Failure to correct the common lateral shift is usually the fault of the therapist, who has not taken enough time to allow a change in the contents of the disc to occur. The lateral shift correction including the restoration of extension must be an unhurried process and may take up to forty-five minutes in difficult patients. Constant repetition of the corrective procedures is necessary.


During the correction period there must be a continual reference to the patient’s symptoms. When there is any suggestion of the production or enhancement of limb pain, treatment must be applied with great caution and a change should be made to the angle of flexion or extension in which the lateral shift is being corrected.

Maintenance of the lordosis following the reduction of the derangement must be emphasised from the first day, and we must ensure that the patient has adequate knowledge to retain his lordosis while sitting. The most common cause of regression or recurrence of symptoms within a few hours of reduction is a poor sitting posture. For example, after a successful reduction a patient may drive home for twenty to thirty minutes and on leaving the car full derangement has recurred. This occurs commonly and must be anticipated. In order to cope with this problem the patient should be provided with a lumbar support — for example, a rolled towel or something similar — to accentuate and support the lordosis in sitting.


In acute cases patients should go home (and not back to work) after reduction has been achieved. On arrival home they should move directly to a mirror and check if derangement has recurred. If so, they should perform the self-correction procedures before it becomes too difficult to reduce the lateral shift without outside help. Then they must lie prone for a few minutes on a bed or on the floor prior to performing a series of extension in lying exercises. This pattern should be repeated each hour or whenever possible throughout the day, and between exercise sessions the patient must be lying and not sitting. On retiring for bed the patient must lie supine in the over corrected position, with a lumbar support in the small of the back to maintain the lordosis, for about thirty minutes before going to sleep. The next morning there is usually a significant reduction in the deformity and pain after the correction procedure has been performed once or twice, although when first awaking the pain may be quite noticeable on movement.

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...
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...
Recovering From Acute Low Back Pain. General Instructions You have recovered from the acute episode because of your ability to master the exercises which relieved your pain. These exercises must be repeated whenever situations arise which have previously caused pain. You must perform the corrective movements before the onset of pain. This is essential. If you carry out the following instruction, you can resume your normal activities without the fear of recurrence. SITTING When sitting for prolonged periods the maintenance of the lordosis is essential. It does not matter if you maintain this with your own muscles or with the help of a supportive roll, placed in the small of your back. In addition to sitting correctly with a lumbar support, you should interrupt prolonged sitting at regular intervals. On extended car journeys you should get out of the car every hour or two, stand upright, bend backwards five or six times, and walk around for a few minutes. BENDING FORWARDS When engaged in activities which require prolonged fo...
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...
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...