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.

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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 to a repeated extension stress.

The centralisation phenomenon must be watched closely. Any suggestion that the pain is moving or increasing peripherally must lead to the immediate but slow lowering of the couch. It is interesting to note that an increase in central low back pain as the couch is lowered nearly always indicates a good response to the treatment, whereas when there is no increase in central pain patients tend to have little or no improvement following this procedure.

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Spine Health. PROCEDURE 17 – SELF-CORRECTION OF LATERAL SHIFT 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 squeez...
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 ...
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...
Lordosis: Causes, Treatments, and Risks What is lordosis? Everyone’s spine curves a little in your neck, upper back, and lower back. These curves, which create your spine’s S shape, are called the lordotic (neck and lower back) and kyphotic (upper back). They help your body: absorb shock support the weight of the head align your head over your pelvis stabilize and maintain its structure move and bend flexibly Lordosis refers to your natural lordotic curve, which is normal. But if your curve arches too far inward, it’s called lordosis, or swayback. Lordosis can affect your lower back and neck. This can lead to excess pressure on the spine, causing pain and discomfort. It can affect your ability to move if it’s severe and left untreated. Treatment of lordosis depends on how serious the curve is and how you got lordosis. There’s little medical concern if your lower back curve reverses itself when you bend forward. You can probably manage your condition with physical therapy and daily exercises. But yo...
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...