Spine Health. PROCEDURE 8 — EXTENSION MANIPULATION

There are many techniques devised for manipulation of the lumbar spine in extension. It is not important which technique is used, provided the technique is performed on the properly selected patient and applied in the correct direction. The technique that I recommend is similar to the first two manipulations described by Cyriax for the reduction of a lumbar disc lesion.

The patient lies prone as for procedure 1. The therapist stands to one side of the patient and, having selected the affected segment, places the hands on either side of the spine as for the technique of extension mobilisation (procedure 7), which is always applied as a premanipulative testing procedure. If following testing the manipulation is indicated, the therapist leans over the patient with the arms at right angles to the spine and forces slowly downwards until the spine feels taut. Then a high velocity thrust of very short amplitude is applied and immediately released.

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Fig. Extension manipulation.

The effects of the external force and the reasons for its use are the same as for procedure 7. When the desired result is not obtained with the mobilising techniques, manipulation is indicated under certain circumstances.

The extension thrust is used by many manipulators, and there is difference of opinion regarding the structures that may be influenced by this technique. Cyriax states that it reduces derangement of an annular fragment of the disc. Others propose reduction of facet locking, tearing of adhesions and reduction of nerve root entrapment. Whatever the true mechanism may be, properly selected patients often experience a click or a dull thud. In most instances the click is followed by a change, usually an improvement, in the patient’s signs and symptoms.

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TYPICAL TREATMENT PROGRESSION — THE POSTURAL SYNDROME The days referred to in the treatment progression are related to treatment sessions which do not necessarily take place on consecutive days. This also applies for the treatment progressions of the dysfunction and derangement syndromes. Day one Assessment and conclusion/diagnosis. Postural discussion ensuring adequate explanation of the nature of the problem. The patient must understand the cause of pain. I usually give the simple example of pain arising from the passively bent forefinger. We must satisfy ourselves and the patient that the pain can be induced and abolished by positioning. If it is not possible to induce pain during the first treatment session, the patient must be instructed mow to abolish pain by postural correction when next it appears. Commence with postural correction exercises and give postural advice; do not try to teach too much the first visit. Discuss the importance of maintenance of the lordosis while sitting prolonged, and demonstrate the u...
TREATMENT OF EXTENSION DYSFUNCTION By far the most common form of ⚡ dysfunction ⚡ is that involving loss of extension. Having already explained and taught the postural requirements, we must now instruct the patient in the methods required to regain lost extension. We must explain to him the reasons for the need to recover the extension movement. The patient must realise that without an adequate range of extension it is not possible to sit with a lordosis, even when a lumbar support is used. For some patients it is imperative that the range of extension be improved, otherwise they will be unable to sit correctly. It is my experience that, following adequate explanation, patients will co-operate with the treatment and work hard at their recovery. They will perform exercises that cause discomfort or even pain, as long as they understand the reasons for doing so. Fig. Recovery of loss of extension, using the procedure of extension in lying. Exercises In order to systematically stretch the lumbar spine in extension, I...
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...
Acute Low Back Pain. General Instructions You must retain the lordosis at all times (lordosis is the hollow in the lower back). Bending forwards as in touching the toes will only stretch and weaken the supporting structures of the back and lead to further injury. Losing the lordosis when sitting will also cause further strain. SITTING When in acute pain you should sit as little as possible, and then only for short periods only. At all times you must sit with a lordosis. Therefore you must place a supportive roll in the small of the back, especially when sitting in a car or lounge chair. If you have the choice you must sit on a firm, high chair with a straight back such as a kitchen chair. You should avoid sitting on a low, soft couch with a deep seat; this will force you to sit with hips lower than knees, and you will round the back and lose the lordosis. The legs must never be kept straight out in front as in sitting in bed, in the bath or on the floor; in this position you are forced to lose the lordosis. W...
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. 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 th...