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.
READ:   Spine Health. PROCEDURE 8 — EXTENSION MANIPULATION

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 that exercises are performed far enough into end range, maintained long enough during the last three repetitions, and performed often enough during the day.
  • Warn for ‘new pains’.

Day three

  • Check posture and exercises.
  • If no improvement, commence mobilisation procedures. Several mobilisation treatments may be required.
  • Patient must continue the self-treatment exercises as directed.

Day four and five

  • Check exercises and progress.
  • If in treatment for flexion dysfunction no further progress is possible with flexion in lying, change to flexion in standing, possibly flexion in step standing.
  • Take necessary precautions when starting flexion in standing.
  • Ensure that patient has ‘new pains’.
READ:   The Intervertebral Disc

Further treatments

  • I prefer to see patients in this category three or four days in succession. If progress is adequate and the patient understands the self-treatment
    programme, treatment may change to alternate days and later to twice per week if required.
  • It usually takes ten to twelve treatments, spread over four to six weeks, to successfully treat dysfunction.
  • If towards the middle of the treatment period the patient ceases to improve and especially if the remaining pain is unilateral, then a rotation manipulation may be required. This may have to be repeated two or three times and should be combined with mobilising and exercising procedures already being applied.
  • Before discharge prophylaxis must be discussed in detail.
READ:   The Derangements and Their Treatment
Spine Health. PROCEDURE 6 — EXTENSION IN STANDING The patient stands with the feet well apart and places the hands (fingers pointing backwards) in the small of the back across the belt line. He leans backwards as far as possible, using the hands as a fulcrum, and then returns to neutral standing. The exercise is repeated about ten times. As with extension in lying it is necessary to move to the very maximum to obtain the desired result. Fig. Extension in standing. Effects: Extension in standing produces similar effects on derangement and dysfunction as extension in lying, but it is less effective in the earlier treatment stages of both syndromes. Whenever extension in lying is prevented by circumstances, an extension stress can be given by extension in standing. In derangement, extension in standing is designed to reduce accumulation of nuclear material in the posterior compartment of the intervertebral joint, provided this accumulation is not gross. In the latter case extension in lying will have to be performed first. Th...
Back pain. Predisposing and Precipitating Factors PREDISPOSING FACTORS Sitting posture There are three predisposing factors in the etiology of low back pain that overshadow most others. The first and most important factor is the sitting posture. A good sitting posture maintains the spinal curves normally present in the erect standing position. Postures which reduce or accentuate the normal curves enough to place the ligamentous structures under full stretch will eventually be productive of pain. Such postures are referred to as poor sitting postures. A poor sitting posture may produce back pain in itself without any additional other strains of living. We have all seen patients who entered an airliner, a car, or even a common lounge chair in a perfectly healthy and painfree state only to emerge hours later crippled with pain and unable to walk upright. Alternatively, a poor sitting posture will frequently enhance and always perpetuate the problems in patients suffering from low back pain. By far the great majority of patients comp...
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...
Kyphosis: Causes, Symptoms and Diagnosis What Causes Kyphosis? Kyphosis, also known as roundback or hunchback, is a condition in which the spine in the upper back has an excessive curvature. The upper back, or thoracic region of the spine, is supposed to have a slight natural curve. The spine naturally curves in the neck, upper back, and lower back to help absorb shock and support the weight of the head. Kyphosis occurs when this natural arch is larger than normal. If you have kyphosis, you may have a visible hump on your upper back. From the side, your upper back may be noticeably rounded or protruding. In addition, people with hunchback appear to be slouching and have noticeable rounding of the shoulders. Kyphosis can lead to excess pressure on the spine, causing pain. It may also cause breathing difficulties due to pressure put on the lungs. Kyphosis in elderly women is known as dowager’s hump. Common causes of kyphosis Kyphosis can affect people of any age. It rarely occurs in newborns because it’s usually caused...
Deformities of the spine: Lordosis, Kyphosis, and Scoliosis ICD-9: 737.20 LORDOSIS ICD-9: 737.10 KYPHOSIS ICD-9: 737.30 SCOLIOSIS Video: How to Correct a Scoliosis With Exercise and Stretching Description ⚡ Lordosis ⚡ is an abnormal inward curvature of the lumbar or lower spine. This condition is commonly called “swayback.” Kyphosis is an abnormal outward curvature of the upper thoracic vertebrae. Commonly, this curvature is known as “humpback” or “round back.” Scoliosis is an abnormal sideward curvature of the spine to either the left or right. Some rotation of a portion of the vertebral column also may occur. Scoliosis often occurs in combination with kyphosis and lordosis. These three spinal deformities may affect children as well as adults. FIGURE. Spinal curvatures Etiology Lordosis, kyphosis, and scoliosis may be caused by a variety of problems, including congenital spinal defects, poor posture, a discrepancy in leg lengths (especially in scoliosis), and growth retardation or a vascular disturbance in the epiphysis of th...