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:   Back Pain History

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:   Spine Health. PROCEDURE 3 — EXTENSION IN LYING

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:   Spine Health. PROCEDURE 14 — FLEXION IN STANDING
Spine Health. PROCEDURE 1 — LYING PRONE The patient adopts the prone lying position with the arms alongside the trunk and the head turned to one side. In this position the lumbar spine falls automatically into some degree of lordosis. Fig. Lying prone. Effects In derangement with some degree of posterior displacement of the nuclear content of the disc the adoption of procedure 1 may cause, or contribute to, the reduction of the derangement provided enough time is allowed for the fluid nucleus to alter its position anteriorly. A period of five to ten minutes of relaxed prone lying is usually sufficient. This procedure is essential and the first step to be taken in the treatment and self-treatment of derangement. In patients with a major derangement, such as those presenting with an acute lumbar kyphosis, the natural lordosis of prone lying is unobtainable. These patients cannot tolerate the prone position unless they are lying over a few pillows, supporting their deformity in kyphosis. In minor derangement situat...
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...
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...
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...
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 ...