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.
READ:   Spine Health. PROCEDURE 3 — EXTENSION IN LYING

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.
READ:   Back Pain History
The Postural Syndrome DEFINITION I would define the postural syndrome as mechanical deformation of postural origin causing pain of a strictly intermittent nature, which appears when the soft tissues surrounding the lumbar segments are placed under prolonged stress. This occurs when a person performs activities which keep the lumbar spine in a relatively static position (as in vacuuming, gardening) or when they maintain end positions for any length of time (as in prolonged sitting). History Patients with postural pain are usually aged thirty or under. Frequently they have a sedentary occupation and in general they lack physical fitness. In addition to low back pain they often describe pains in the mid-thoracic and cervical areas. They state that the pain is produced by positions and not by movement, is intermittent and may sometimes disappear for two to three days at a time. It is often found that, when patients are more active at weekends — playing tennis and dancing — they have relatively little or no t...
Spine Health. PROCEDURE 15 — FLEXION IN STEP STANDING In this procedure the patient stands on one leg while the other leg rests with the foot on a stool so that hip and knee are about ninety degrees flexed. Keeping the weight bearing leg straight the patient draws himself into a flexed position, firmly approximating the shoulder and the already raised knee (both being on the same side). If possible the shoulder should be moved even lower than the knee. The patient may apply further pressure by pulling on the ankle of the raised foot. The pressure is then released and the patient returns to the upright position. The sequence is repeated about six to ten times. It is important that the patient returns to neutral standing and restores the lordosis in between each movement. Fig. Flexion in step standing. Effects: This procedure causes an asymmetrical flexion stress on the affected segments. It is applied when there is a deviation in flexion, which may occur in dysfunction as well as derangement. Both in dysfunction and derangement th...
TREATMENT OF SIDE GLIDING DYSFUNCTION — CORRECTION OF SECONDARY LATERAL SHIFT 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 the...
TREATMENT OF EXTENSION DYSFUNCTION 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. Exercises In order to systematically stretch the lumbar spine in extension, I...
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 ...