Typical treatment progression: The postural syndrome
| Day |
Treatment |
| One |
- Assessment and conclusion/diagnosis.
- Postural discussion insuring adequate explanation of the nature
of the problem. The patient must understand the cause of pain.
I usually give the simple example of pain arising from the passively
bent forefinger.
- We must satisfy ourselves and the patient that the pain can
be induced and abolished by positioning. If it is not possible
to induce pain during the first treatment session, the patient
must be instructed how to abolish pain by postural
correction
when it next appears.
- Commence with postural correction exercises and give postural
advice; do not try to teach too much the first visit.
- Discuss
the importance of maintenance of the lordosis while sitting prolonged,
and demonstrate the use of lumbar supports in sitting and lying.
|
| Two |
- Confirm diagnosis.
- Check results. If the patient was unsuccessful in controlling
the postural pain on his own, it is possible that we have not
taught correction well enough. It also may be that the patient
has not corrected his posture adequately or maintained the corrected
posture long enough. When confronted with such a suggestion in
an accusing manner, patients often feel offended and deny having
slouched. We must be tactful when discussing these points.
- If possible have the patient produce and abolish the pain; otherwise
inquire as to his ability to abolish the pain during the
preceding
twenty-four hours by correcting the posture whenever pain appeared.
- Check the exercises. It is surprising how often patients alter
the exercises without realizing it.
- Repeat the postural advice in full.
- Inform the patient that 'new pains' are to be expected as a
result of adjustment to different postural habits.
|
| Three |
- Treatment as for
day two.
- Once the patient is adequately controlling his postural stresses,
treatment may be altered from a daily basis to every second or
third day.
- Once the pain occurs only occasionally and can be well controlled,
the patient may stop the 'slouch-overcorrect' exercise.
- Reassure regarding the onset of 'new' postural pains.
|
Four
and Five |
- Check exercises and progress.
- Deal with any other postural pain that may have become apparent.
- Deal with other situations which may have previously
been overlooked.
|
Further
treatments |
- A few check-ups at greater intervals may be necessary to ensure the patient has
full control of his postural pain.
- We must ensure that the patient has adequately stressed the
joints and is engaged in all normal activities.
- Discuss the consequences of postural neglect.
- Before discharge, prophylaxis must be discussed in detail.
|
