Management

• explanation and reassurance

• analgesics for a painful episode

• spinal mobilisation or manipulation

• exercise program

• preventive program

Spinal mobilisation and manipulation

Spinal mobilisation is helpful but the more forceful manipulative therapy produces better and quicker results. There are many techniques that can be employed, the choice depending on which part of the back is affected. 1 The sternal thrust (Nelson hold) technique is widely used for upper thoracic segments and the crossed pisiform technique (patient prone) or posteroanterior indirect thrust (patient supine—Fig. 34.8), which is the most effective for mid-thoracic spine.

REPRODUCED FROM C. KENNA AND J. MURTAGH, BACK PAIN AND SPINAL MANIPULATION (2ND EDITION), BUTTERWORTH-HEINEMANN, 1997, WITH PERMISSION

Preventive exercise program

A key to helping these patients who are prone to recurrences is to prescribe an exercise program for their thoracic spine. 1 6

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