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.

READ:   PAIN AND ITS TREATMENT MODELS

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.

READ:   The Derangements and Their Treatment
TREATMENT OF FLEXION DYSFUNCTION Loss of flexion is the second most common movement loss in the lumbar spine. It manifests itself in several ways, which interfere with either the amount of available flexion or the pathway taken to achieve flexion. This type of dysfunction is commonly seen in patients with an accentuated lordosis. Patients with significant flexion dysfunction are usually unable to sit slouched with a convex lumbar spine. When giving postural instructions to these patients, we must explain that once sitting relaxed they place the lumbar spine on full stretch much sooner than patients with a normal flexion excursion. Fig. Recovery of loss offlexion, using the procedure of flexion in standing. Recovery of pure flexion loss To regain flexion we must, just as in the case of extension dysfunction, explain to the patient the purpose of performing exercises. Again, we must stress the necessity of causing a moderate degree of discomfort or pain with the exercises. Pain produced by stretching of contra...
Back pain. The Cause of Pain THE NOCICEPTIVE RECEPTOR SYSTEM Most tissues in the body possess a system of nerve endings which, being particularly sensitive to tissue dysfunction, may be referred to as nociceptive receptors. The free nerve endings of the nociceptive system provide the means by which we are made aware of pain. Wyke describes the distribution of the nociceptive receptor system in the lumbar area: it is found in the skin and subcutaneous tissue; throughout the fibrous capsule of all the synovial apophyseal joints and sacro-iliac joints; in the longitudinal ligaments, the fiaval and interspinous ligaments and sacro-iliac ligaments; in the periosteum covering the vertebral bodies and arches, and in the fascia, aponeuroses and tendons attached thereto; and also in the spinal dura mater, including the dural sleeves surrounding the nerve roots. The nociceptive innervation of the spinal ligaments varies from one ligament to another. The system is found to be most dense in the posterior longitudinal l...
Hyperlordosis: Treatment, Prevention, and More What’s hyperlordosis? Human spines are naturally curved, but too much curve can cause problems. Hyperlordosis is when the inward curve of the spine in your lower back is exaggerated. This condition is also called swayback or saddleback. Hyperlordosis can occur in all ages, but it’s rare in children. It’s a reversible condition. Keep reading to learn about the symptoms and causes of hyperlordosis and how it’s treated. What are the symptoms of hyperlordosis? If you have hyperlordosis, the exaggerated curve of your spine will cause your stomach to thrust forward and your bottom to push out. From the side, the inward curve of your spine will look arched, like the letter C. You can see the arched C if you look at your profile in a full-length mirror. You may have lower back pain or neck pain, or restricted movement. There’s limited evidence connecting hyperlordosis to lower back pain, however. Most hyperlordosis is mild, and your back remains flexible. If the arch in your bac...
Low Back Pain. Contraindications Although it has been accepted throughout that all patients have received adequate medical screening, occasionally patients with serious pathology or mechanical disorders unsuited to mechanical treatment are encountered during routine examination. If in the examination no position or movement can be found which reduces the presenting pain, the patient is unsuited for mechanical therapy, at least at this time. The existence of serious pathology should be considered when the history states that there has been no apparent reason for the onset of symptoms; that the symptoms have been present for many weeks or months, and have during that time increased in intensity; and that they are constant; and the patient feels that he is gradually getting worse. On examination the pain remains exactly the same, irrespective of positions assumed or movements performed. Usually there is little loss of function if any, and postural deformity is not often seen. In addition to the examination finding, th...
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...