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.


In order to systematically stretch the lumbar spine in extension, I have adopted a system in which the patient is able to use gravity and his own body weight to apply enough force for adequate passive stretching of the joints of the lumbar spine. This procedure, a modified press-up exercise, is extension in lying. If with this exercise the desired result is not obtained quickly enough or if progress ceases, extension in lying with belt fixation must be commenced.

If due to circumstances it is absolutely impossible to perform extension exercises in lying, extension in standing must be performed instead. But it must be emphasised that a far better extension stretch is obtained with extension exercises in lying.


The patient should be instructed to perform the exercise ten times on each occasion, and to repeat the series ten times a day at intervals of approximately two hours. It is most important to ensure that stretching occurs very regularly and the patient does not let more than two to three hours pass by without doing so.

The exercise routine should result in an increase of localised central back pain which subsides within ten to twenty minutes. The patient should also develop some new pains higher up in the spine and across the shoulders. These are normally the result of performing new exercises and holding a new posture. It is necessary to explain that the combination of the new posture and exercises will result in discomfort felt in other places; that this new aching is unavoidable and indeed necessary, but will pass after a week or so. Patients who do not complain of these transitional pains are probably not exercising adequately.

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Irrespective of the category in which they may fall, all patients should be warned of the significance of producing peripheral pain. If exercises are found to produce peripheral pain, the patient should stop and wait until the next treatment when further advice should be sought.

The loss of function in patients in this group is usually resolved gradually over a period of about four to six weeks. After this period the patient may reduce the number of times the exercises are performed to four sessions per day, maintaining the number of ten repetitions at each session. I instruct my extension dysfunction patients that they should continue the programme and perform ten exercises twice daily for the rest of their lives.

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Often it is desirable to keep some record of progress and the therapist may choose to take photographs to evaluate the improvement in the lumbar extension curve. The improvement is most evident in the first week, and therefore the first photographs should be taken on the first day prior to the commencement of the self-treatment programme.

Special techniques

As soon as progress slows down or ceases it is time to add mobilisation techniques. If after three to four mobilisation treatments no change is evident, the patient should be manipulated. Special techniques of mobilisation and manipulation are indicated, when the patient is unable to fully restore lumbar extension himself. These procedures may ensure full recovery of extension provided the extension exercises in lying are continued as well.

The Derangements and Their Treatment DERANGEMENT ONE Central or symmetrical pain across L4/5. Rarely buttock or thigh pain No deformity In Derangement One the disturbance within the disc is at a comparatively embryonic stage. Due to minor posterior migration of the nucleus and its invasion of a small radial fissure in the inner annulus, there is a minimal disturbance of disc material. This causes mechanical deformation of structures posteriorly within and about the disc, resulting in central or symmetrical low back pain. The accumulation of disc material also leads to a minor blockage in the affected joint preventing full extension, but the blockage is not enough to force the deformity of kyphosis upon the joint. In patients with Derangement One the history, symptoms and signs are usually typical of the syndrome, and the test movements confirm the diagnosis of derangement. Because the disturbance within the joint is relatively small it responds well to the patients’ own movements, and the majority of pati...
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...
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...
The Derangement Syndrome Of all mechanical low back problems that are encountered in general medical practise, mechanical derangement of the intervertebral disc is potentially the most disabling. It is my belief that in the lumbar spine, if in no other area, disturbance of the intervertebral disc mechanism is responsible for the production of symptoms in as many as ninety-five percent of our patients. Twenty-five years of clinical observation and treatment of lumbar conditions have convinced me that certain phenomena and the various movements which affect them, can occur only because of the hydrostatic properties invested in the intervertebral disc. For thirty years Cyriax has attributed lumbar pain to internal derangement of the intervertebral disc mechanism. He has outlined the cause of lumbago, and proposed that pain of a slow onset is likely to be produced by a nuclear protrusion while that of a sudden onset is caused by a displaced annular fragment. Although at present we are unable to prove either of ...
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...