Typical treatment progression: The dysfunction syndrome
- 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
- 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 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'.
- Check posture and exercises.
- If no improvement, commence mobilization procedures.
Several mobilization treatments may be required.
- Patient must continue the self-treatment exercises
- 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
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.