Physical therapy

Active exercises are the best form of physical therapy (Fig 33.14 a, b).

Spinal mobilisation is a gentle, repetitive, rhythmic movement within the range of movement of the joint. It is safe and quite effective (Fig 33.16).

Fig. 33.16 Lumbar spinal mobilisation: illustration of the effective forces involved REPRODUCED FROM C. KENNA AND J. MURTAGH, BACK PAIN AND SPINAL MANIPULATION, BUTTERWORTHS, SYDNEY, 1989, WITH PERMISSION

Spinal manipulation is a high velocity thrust at the end range of the joint. It is generally more effective and produces a faster response but requires accurate diagnosis and greater skill. It is extremely effective for uncomplicated persistent dysfunctional low back pain (without radicular pain) and, together with exercises, is the treatment of choice (Fig 33.17). 10 11 12

Fig. 33.17 Lumbar spinal mobilisation (for left-sided pain): illustration of the specific technique for the L4-L5 level with arrows indicating the direction of applied force

REPRODUCED FROM C. KENNA AND J. MURTAGH, BACK PAIN AND SPINAL MANIPULATION, BUTTERWORTHS, SYDNEY, 1989, WITH PERMISSION

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