Answer to Question 2
The therapy, which corresponds most closely to this interpretation of
the problem, is the McKenzie Therapy. This is taught inside the physiotherapy
profession. Robin McKenzie was a physiotherapist. His book “Treat Your Own Back”
is well known to all those treating back pain. The typical exercise of the
McKenzie system is what I call the “floppy press up”
This will tend to restore the wedge shape of the lowest lumbar discs
where this has been lost for whatever reason. I look upon this as a very
important bit of evidence. Although I am qualified as a chiropractor, I am
trained in Mackenzie by the Mackenzie Institute UK and I use it in most acute
back pain cases of recent onset. In the trial published in the BMJ in
1990, neither manipulative physiotherapy nor chiropractic was particularly
effective in the early stages of an acute LBP attack. This is exactly
when Mackenzie is most effective. It can completely stop the attack in
its tracks. If the person is careful with sitting and uses my pelvic supports
when driving they can be back to square one quite quickly. My
interpretation is that the Mackenzie extension exercise squeezes the nucleus
back to the anterior of the disk where it should be all the time in L 4 5 or 5
S.
P S Although the Mackenzie extension exercise works well I find it even
more effective to apply the extension force directly to the pelvis, rather than
using the legs as lever. With the patient supine I put a cushion under
the knees to take the tension out of the psoas and then I lift the iliac crest
on each side with both my hands. I pull upwards and towards the patient's
feet to apply an extension plus tension to the lumbo sacral junction area.
For a light person where I can apply sufficient force this is much more
effective than standard Mackenzie. Sometimes I, and the patient, can feel
the nucleus oozing back to where it should be!