Having observed thousands of lumbar spines it has become clear to me that asymmetry is the ‘norm’ and symmetry is almost atypical. Therefore, when examining dysfunction patients it is important to realise that many exhibit a minor scoliosis or lateral shift, the direction of which is sometimes extremely difficult to determine. With careful observation it can be seen that the top half of the patient’s body is not correctly related to the bottom half, and the patient has shifted laterally about the lumbar area. The anomalies include a number of lateral shifts now dysfunctional in character. These lateral shifts are referred to as secondary whereas those caused by derangement are primary.
Fig. Recovery of loss of side gliding, leaching the procedure of self-correction of secondary lateral shift.
As discussed previously, we must determine whether the lateral shift is relevant to the present symptoms or is merely a congenital or developmental anomaly. If side gliding produces pain there is likely to be adaptive shortening within or about the disc and recovery of the side gliding movement must be attempted. As it is not easy to apply overpressure in the side gliding exercise, it may be difficult to recover this movement.
The patient must be fully instructed in self-correction of lateral shift (Proc. 17). He should perform the procedure ten times per day, at each session moving ten times into the overcorrected position. The last movement should be held firmly for about thirty to forty seconds. The patient should also be encouraged to stand in the overcorrected position whenever an opportunity arises during the day. If by the end of the first week pain produced by lateral shift correction is much less, the procedure will most likely have the desired result and must be continued for about three to four weeks in an attempt to restore full function. But if no change is evident after one week, there is little hope of improving this aspect of dysfunction.