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 use of lumbar supports in sitting and lying.
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Day two

  • Confirm diagnosis.
  • Check results. If the patient was unsuccessful in controlling the postural pain on his own, it is possible that we have not taught correction well enough. It also may be that the patient has not corrected his posture adequately or maintained the corrected posture long enough. When confronted with such a suggestion in an accusing manner, patients often feel offended and deny having slouched. We must be tactful when discussing these points.
  • If possible have the patient produce and abolish the pain; otherwise enquire as to his ability to abolish the pain during the preceeding twenty-four hours by correcting the posture whenever pain appeared.
  • Check the exercises. It is surprising how often patients alter the exercises without realising it.
  • Repeat the postural advice in full.
  • Inform the patient that ‘new pains’ are to be expected as a result of adjustment to different postural habits.
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Day three

  • Treatment as for day two.
  • Once the patient is adequately controlling his postural stresses, treatment may be altered from a daily basis to every second or third day.
  • Once the pain occurs only occasionally and can be well controlled, the patient may stop the ‘slouch-overcorrect’ exercise.
  • Reassure regarding the onset of ‘new’ postural pains.

Day four and five

  • Check exercises and progress.
  • Deal with any other postural pain that may have become apparent.
  • Deal with other situations which may have previously been overlooked.

Further treatments

  • A few check-ups at greater intervals may be necessary to ensure the patient has full control of his postural pain.
  • We must ensure that the patient has adequately stressed the joints and is engaged in all normal activities.
  • Discuss the consequences of postural neglect.
  • Before discharge prophylaxis must be discussed in detail.
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The Intervertebral Disc STRUCTURE In the lumbar spine the intervertebral discs are constructed similarly to those in other parts of the vertebral column. The disc has two distinct components: the annulus fibrosus forming the retaining wall for the nucleus pulposus. The annulus fibrosus is constructed of concentric layers of collagen fibres. Each layer lies at an angle to its neighbour and the whole forms a laminated band which holds the two adjacent vertebrae together and retains the nuclear gel. The annulus is attached firmly to the vertebral end plates above and below, except posteriorly where the peripheral attachment of the annulus is not so firm. Moreover, the posterior longitudinal ligament with which the posterior annulus blends is a relatively weak structure, whereas anteriorly the annulus blends intimately with the powerful anterior longitudinal ligament. The posterior part of the annulus is the weakest part: the anterior and lateral portions are approximately twice as thick as the posterior port...
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