Typical treatment progression: Derangement one
| Day |
Treatment |
| One |
- Assessment and conclusion/diagnosis.
- Explanation of cause of derangement and treatment approach.
- Reduction of derangement: commence with lying prone, lying prone
in extension, extension in lying.
- Instruct to maintain lordosis at all times, must sit with lordosis
and insert lumbar support. May benefit from supportive roll in
bed.
- Repeat extension procedures each hour to maintain reduction
and prevent recurrence.
- If extension in lying is not possible, it must be replaced by
extension in standing.
- On recurrence of symptoms watch maintenance of lordosis even
more, and immediately perform extension in lying.
- Demonstrate the use of lumbar supports in siting and lying.
|
| Two |
- Confirm diagnosis.
- Check sitting posture and exercises.
- If improving then change nothing other than reducing extension
in lying to once every two hours; replace extension in lying with
extension in standing when necessary.
- If no improvement at all then check that exercises are performed
far enough into extension, often enough during the day, and that
the lordosis is well kept.
- Add extension mobilization, possibly rotation
mobilization in extension.
- Warn for 'new pains.'
|
| Three |
- Check sitting posture and exercises.
- If improving continue with procedures as directed.
- Once constant pain has changed to intermittent pain, Stop
lying prone and lying prone in extension; start the slouch-over correct
exercise.
- If no improvement, concentrate on mobilization techniques and
add extension manipulation.
|
| Four |
- Check exercises and progress.
- If progress is satisfactory, reduce treatment to three times
per week.
- Continue with the same program until pain free for three
days at least.
- If progress is unsatisfactory, repeat mobilization and
manipulation technique.
|
Five
and Seven |
- Check exercises and progress.
- Once pain free for three days, reduce extension in lying
to three times per day and replace it by extension in standing whenever
necessary during the day.
- Commencing flexion in lying; take all necessary precautions.
- Flexion in lying must be followed by extension in lying.
|
Further
treatments |
- I prefer to see
patients with derangement every day until the reduction is stable
and patients are in control. This may take up to five days. Then
the treatment might be reduced to alternate days.
- Once reduction of derangement proves stable and the patient
has been pain free for at least three days, flexion
exercises may be started to recover function.
- All flexion exercises must be followed by extension in lying;
if this is not possible extension in standing must be performed.
- When no further flexion can be gained with flexion in lying,
the patient must start flexion in standing.
- When function is recovered flexion in standing may cease.
- The patient is advised to continue with the exercises for another
six weeks to prevent recurrence: he will do extension in lying
in the morning; flexion in lying followed by extension in lying
in the evening; extension in standing whenever necessary during
the day; and possibly the slouch--over correct exercise, whenever
becoming negligent regarding sitting.
- Before discharge, prophylaxis and self-treatment must be
discussed in detail. We must emphasize that self-treatment is infinitely
preferable to dependence on therapy.
|
