This procedure has two parts: first the deformity in scoliosis is corrected; then, if present, the deformity in kyphosis is reduced and full extension is restored. The patient, standing with the feet about thirty centimeters apart, is asked to clearly define the areas where pain is being felt at present. The therapist stands on the side to which the patient is deviating and places the patient’s near elbow at a right angle by his side. The elbow will be used to increase the lateral pressure against the patient’s rib cage.
The therapist’s arms encircle the patient’s trunk, clasping the hands about the rim of the pelvis. Now the therapist presses his shoulder against the patient’s elbow, pushing the patient’s rib cage, thoracic and upper lumbar spine away while at the same time drawing the patient’s pelvis towards himself. In this manner the deformity in scoliosis is reduced and, if possible slightly overcorrected.
Initially, there will be significant resistance to the procedure, which may actually cause an increase in pain. It is quite safe to continue with correction as long as centralisation of pain takes place, and therefore the patient must be questioned continually about the behaviour of his pain. Relaxation of the patient during the procedure is very important and we should always try to get the patient to ‘let it all go’. The first pressure in the series should be a gentle gradual squeeze which is held momentarily and then released. After this an accurate assessment of the patient’s reactions must be made. Experience has taught me that too much pressure or too fast a correction in the initial stages may result in fainting and collapse of the patient. If well tolerated the pressure is applied a little further each time. As correction progresses over ten to fifteen rhythmically applied pressures, the patient usually describes that the pain moves from a unilateral to a central position, and by the time over correction is achieved there will be a significant reduction in intensity of the pain or the pain may have moved slightly to the opposite side. If after a few rhythmical pressures no progress is made in the correction, it may be necessary to apply a longer and more sustained pressure.
Sometimes reduction may be felt clearly by the therapist and the patient’s trunk is felt to move slowly but surely from its previously held position. In lightly-built or tall and slender patients shift correction may occur quite easily, and only a few minutes of ten to fifteen pressures are required to reduce the derangement. On the other hand, some acute lateral shifts are extremely difficult to reduce and one may have to perform five or six series of corrective pressures.
Assuming that correction of the deformity in scoliosis has been achieved, we must now proceed with restoring the lumbar lordosis. This is preferably commenced in the standing position. The patient no longer exhibits a lumbar scoliosis but may still have a kyphosis. The therapist, holding the patient as for correction of the scoliosis, must maintain slight over correction while moving the low back of the patient into the beginning of extension. A few movements will indicate the ease with which the lordosis will be restored. If the extension range improves rapidly it is usually belter to recover as much extension as possible in the standing position. If extension does not increase rapidly, then it is better to change to extension in lying. This procedure should produce a steady and continuing reduction of central pain, and it should automatically follow for all patients with a postero-lateral derangement once the scoliosis has been corrected and the symptoms have centralised.
Fig. Correction of lateral shift.
These will be discussed following the next procedure.