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:   The Derangement Syndrome

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.
READ:   Spine Health. PROCEDURE 5 — SUSTAINED EXTENSION

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:   Low Back Pain. Contraindications
Spinal manipulation techniques There are many differing philosophies and concepts surrounding the practise of spinal manipulation and its effects on the pathologies which may exist in the spine. To satisfy all these philosophies an equal number of institutions has developed, teaching those wishing to learn. No matter what school presents its case or which philosophy is adhered to, all manipulative specialists claim to have a high success rate. They all use techniques which vary in nature, application and intent; they proclaim that their own methods are superior to those used by others; and yet, somehow they all obtain uniformly good results. Self-limitation of low back pain plays, of course, a significant role in this happy situation. Apart from this there are definite benefits which are obtained quickly by using manipulative techniques. Throughout the years I have practised many forms of mobilisation and manipulation, including osteopathic and chiropractic techniques and those taught by Cyriax. I have come to be...
Spine Health. PROCEDURE 14 — FLEXION IN STANDING The simple toe touching exercise in standing does not need much elaboration. The patient, standing with the feet about thirty centimeters apart, bends forward sliding the hands down the front of the legs in order to have some support and to measure the degree of flexion achieved. On reaching the maximum flexion allowed by pain or range, the patient returns to the upright position. The sequence is repeated about ten times, should be performed rhythmically, and initially with caution and without vigour. It is important to ensure that in between each movement the patient returns to neutral standing. Fig. Flexion in standing. Effects: Flexion in standing differs from flexion in lying in various ways. Naturally, the gravitational and compressive forces act differently in both situations. In flexion in standing the movement takes place from above downwards, and the lower lumbar and lumbo-sacral joints are placed on full stretch only at the end of the movement. In addition, the lumbo...
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...
TREATMENT OF THE DERANGEMENT SYNDROME Of all patients with low back pain those having derangement of the intervertebral disc are the most interesting and rewarding to treat. As in dysfunction, it is essential in derangement that from the very first treatment correction of the sitting posture be achieved, but in the early and acute stages of derangement emphasis is placed on the maintenance of lordosis rather than the obtaining of the correct posture. Failure in this respect means failure of what otherwise might be a successful reduction of the derangement. So often it occurs that a patient describes a significant relief from pain and is visibly improved immediately following treatment, but later that same day after sitting for some time he is unable to straighten up on rising from sitting and the symptoms have returned just as they were before treatment. Usually the patient clearly understands the dangers of bending and stooping and carefully avoids these movements. But the hidden dangers of sustained flexion incurred in t...
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...