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Mechanical Low Back Pain

Progression of Treatment


Dysfunction Syndrome

Typical treatment progression: The dysfunction syndrome
Day Treatment
One
  • 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.
  • Emphasize 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.
Two
  • Confirm diagnosis.
  • Check postural correction.
  • Completely repeat postural correction and instructions.
  • Check exercises. If improving, nothing should be changed.
  • If the patient is 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'.
Three
  • Check posture and exercises.
  • If no improvement, commence mobilization procedures. Several mobilization treatments may be required.
  • Patient must continue the self-treatment exercises as directed.
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'.
Further
treatment
  • 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 program, 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 mobilizing and exercising procedures already being applied.
  • Before discharge, prophylaxis must be discussed in detail.

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Last Update: September 11 2012