- Assessment and conclusion/diagnosis.
- Explanation of the cause of dysfunction and the treatment approach.
- Postural correction and instructions, especially regarding sitting; demonstrate the use of a lumbar support.
- Commence with exercises to recover function — that is, extension in lying, flexion in lying, or side gliding in standing, whatever procedure is indicated.
- Emphasise the need to experience some discomfort during the exercises, and the importance of frequent exercising during the day.
- If flexion in lying is recommended, we must warn to stop exercising if the symptoms quickly worsen. We may have overlooked derangement, or commenced the procedure too early following recent derangement.
- Always follow flexion exercises with some extension.
- Confirm diagnosis.
- Check postural correction.
- Completely repeat’postural correction and instructions.
- Check exercises. If improving nothing should be changed.
- If not improving, ensure that exercises are performed far enough into end range, maintained long enough during the last three repetitions, and performed often enough during the day.
- Warn for ‘new pains’.
- Check posture and exercises.
- If no improvement, commence mobilisation procedures. Several mobilisation treatments may be required.
- Patient must continue the self-treatment exercises as directed.
Day four and five
- Check exercises and progress.
- If in treatment for flexion dysfunction no further progress is possible with flexion in lying, change to flexion in standing, possibly flexion in step standing.
- Take necessary precautions when starting flexion in standing.
- Ensure that patient has ‘new pains’.
- I prefer to see patients in this category three or four days in succession. If progress is adequate and the patient understands the self-treatment
programme, treatment may change to alternate days and later to twice per week if required.
- It usually takes ten to twelve treatments, spread over four to six weeks, to successfully treat dysfunction.
- If towards the middle of the treatment period the patient ceases to improve and especially if the remaining pain is unilateral, then a rotation manipulation may be required. This may have to be repeated two or three times and should be combined with mobilising and exercising procedures already being applied.
- Before discharge prophylaxis must be discussed in detail.