When Mr. Lumbar's symptoms centralized and then diminished on test movements the transition from evaluation to treatment took place. The most significant lesion, a posterior lateral derangement (D3), was treated initially with symmetrical extension in lying, that is, the patient did pressups (video) which are like pushups only the pelvis remains on the supporting surface. If the symptoms respond favorably, the patient increases the rigor and range of the pressups.
The patient was instructed to repeat the exercise every hour for that day, and until seen again in the clinic the following day. The importance of maintaining a lordosis (the hollow in the low back) 100% of the time was emphasized, especially during sitting, and it was practiced until the patient became proficient in maintaining the corrected posture.
Other possible instructions to the patient are described below in the sections on Derangement syndrome and Prevention.
On the second visit it was noted that the patient had been able to maintain his corrected posture. His symptoms were limited to pain in the right L 4-5 area (a pain score of 3/10). An additional technique was added to his treatment regimen, that of "over correction of the primary lateral shift" while doing extensions in lying. This is accomplished by moving the patient's hips away from the side of the pain while completing sets of pressups. While there was no observable left lateral shift, the patient was positioned with an "over correction" (hips to the left) in an attempt to centralize and abolish the symptoms. The patient's pain was centralized. His pain now rated 2/10 on self report.
The patient's home exercise program was reduced to 10 pressups every two waking hours with continuous maintenance of the lumbar lordosis. Sitting posture and exercise technique were reviewed with the patient.
On the third visit the patient rated his central L 4-5 pain at 1/10. The therapist's technique of extension mobilization combined at intervals with rotation mobilization in extension were applied to the lower lumbar segments. These were followed immediately by extension in lying. All lumbar pain was eliminated following the second set of pressups.
Typical treatment progressions for the three syndromes: