To apply a sustained extension stress to the lumbar spine an adjustable couch, one end of which may be raised, is a necessary piece of equipment. The patient lies prone with his head at the adjustable end of the couch which is gradually raised, about one to two inches at the time over a five to ten minute period. Once the maximum possible degree of extension is reached, the position may be held for two to ten minutes, according to the patient’s tolerance. When lowering the patient the adjustable end of the couch should slowly be returned to the horizontal over a period of two to three minutes. This must not be done rapidly, for acute low back pain may result.
Fig. Sustained extension.
The procedure is predominantly used in the treatment of derangement. The effect is similar to that of the third procedure, but a time factor is added with the graduated increase and the sustained nature of the extension. In certain circumstances a sustained extension stress is preferable to a repeated extension stress.
The centralisation phenomenon must be watched closely. Any suggestion that the pain is moving or increasing peripherally must lead to the immediate but slow lowering of the couch. It is interesting to note that an increase in central low back pain as the couch is lowered nearly always indicates a good response to the treatment, whereas when there is no increase in central pain patients tend to have little or no improvement following this procedure.