Training ladder for: SLIPPED DISC (PROLAPSUS DISCI INTERVERTEBRALIS LUMBALIS)
STEP 1
The rehabilitation program mentioned below is primarily aimed at patients that have not undergone surgery. Patients operated on for a slipped disc should consider the following exercises as a supplement to the guidelines furnished by the doctor that performed the operation. Specific precautions are necessary as the surgery can be complicated. Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.
The indications of time after stretching, coordination training and strength training show the division of time for the respective type of training when training for a period of one hour. The time indications are therefore not a definition of the daily training needs, as the daily training is determined on an individual basis.
Nothing.
(20 min)
Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.
Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.
Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.
Squat with the injured leg outstretched behind you as far as possible with the foot on a box. Thrust your hip forward and down without swaying your back so that the front of the hip becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back with one leg over the other, and hold behind the lower leg’s knee. Draw the leg up towards your head so that the buttock on the upper leg becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.
Stand with the injured leg stretched backwards with the toes facing front. Slowly bend the knee so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Stand with the injured leg outstretched with the ankle joint bent up against the wall. Press your abdomen against the wall so that the calf muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
(5 min)
Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.
Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.
(35 min)
Sit on a chair with slightly curved back. Thrust your stomach forward and hold the sway-backed position.
Lie on your stomach across a table or chair and support with both arms on the floor. Raise one arm from the floor and hold the position for approx. 10 seconds. Change arm.
Go down on all fours. Alternately lift and stretch the right and left legs, fully stretching the knee.
Lie on your back with knees bent and arms stretched out to your sides. Keeping your feet together, move your knees alternately right and left while looking in the opposite directions.
Stand with your side against a wall. Support with your shoulder against the wall and press your hip in to the wall for 10 seconds. Rest for 10 seconds before repeating.
Lie on your stomach with both arms above your head. Lift your upper body.
Lie on your side on a mattress or bench. Flex the lower part of the leg and stretch the upper part. It is important to completely stretch the hip. Lift the upper leg upwards with the heel pointing towards the ceiling. Gradually increase the load by attaching a sandbag to the ankle.
Lie on your side on a mattress or bench. Stretch the lower leg whilst the upper leg is slightly bent. Lift the lower leg stretched upwards. Gradually increase the load by attaching a sandbag to the ankle.
Stand with the elastic around the injured leg, facing towards the elastic. Move the leg backwards and slowly forwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.
Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.
Surgical treatment of lumbar disk prolapse. A 20-year material.
Fiane AE, Bugge W, Odegard O, Kleven H. Tidsskr Nor Laegeforen 1992 Jan 30;112(3):325-7.
Surgery for herniated lumbar discs was performed on approximately 700 patients during the period 1963-83. 500 patients with a median observation of 13.5 years (5-25 years) were included in a follow-up study by reviewing journals and using a questionnaire. 35 of these patients (7%) had an acute operation. 398 patients (79.6%) were satisfied with the operation. There was a high positive correlation between the radiologic and peroperative findings and few complications after operation. 59 patients (11.8%) were reoperated and 94 patients (18.8%) were later hospitalized without operation because of lumbar pain. We conclude that patients who are to have surgery must be carefully selected, and that patients should be informed about the degenerative process, and the marked possibility of residual or repeated herniation and continuing lumbar pain.
Complications of surgery for discogenic disease of the spine.
Abramovitz JN. Neurosurg Clin N Am 1993 Jan;4(1):167-76.
Disc disease is benign and not life threatening. Its long-term prognosis is uncertain, and spontaneous recoveries are common. The decision to perform surgery thus carries with it a heavy responsibility to provide safe treatment. “Good safe surgical technique” is essential, but it is much more than a well-rehearsed routine procedure. From preoperative evaluation to surgery to postoperative care, the surgeon must look ahead to problems that might arise. Where anticipated risks cannot be avoided, they should be minimized, and when adverse events occur, active recognition will lead to early and accurate management.
Training ladder for: LUMBAGO (INSUFFICIENTIA DORSI)
STEP 4
Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.
Unlimited: Cycling. Swimming. Running with increasing distance and small jumps on a soft surface.
(15 min)
Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.
Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.
Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back with one leg over the other, and hold behind the lower leg’s knee. Draw the leg up towards your head so that the buttock on the upper leg becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back and draw your knee up towards your head while lifting your head so that your back becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.
(5 min)
Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.
Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.
(40 min)
Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.
Lie on your stomach across a chair with both feet supported under a tabletop. Lift both hands from the floor and hold the position for 2 seconds. Support with your hands for 2 seconds and repeat the exercise 10 times in quick succession.
Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.
Lie on your back and place your hands behind your neck. Alternately move your right elbow towards left knee, and left elbow towards right knee.
Go down on all fours. Lift right arm and left leg and hold the position for a few seconds, followed by left arm and right leg and hold for a few seconds.
Lie on your back with bent knees. Lift one leg and stretch while at the same time lifting your hip from the floor.
Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.
Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.
Training ladder for: LUMBAGO (INSUFFICIENTIA DORSI)
STEP 3
Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.
Unlimited: Cycling. Swimming. Running over short distances on a soft surface.
(15 min)
Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.
Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.
Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back with one leg over the other, and hold behind the lower leg’s knee. Draw the leg up towards your head so that the buttock on the upper leg becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back and draw your knee up towards your head while lifting your head so that your back becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.
(5 min)
Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.
Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.
(40 min)
Go down on all fours. Alternately lift and stretch the right and left legs, fully stretching the knee.
Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.
Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.
Sit on a chair with a broom handle behind your back as shown in the sketch. Rotate from side to side at a steady pace.
Lie on your back with bent legs. Lift your hip from the floor and hold the position for 5 seconds. Rest for 5 seconds before repeating.
Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.
Lie on your back with bent knees. Lift one leg and stretch while at the same time lifting your hip from the floor.
Lie on your back and place your hands behind your neck. Move your head and knees towards each other. Remember not to pull on your neck during the exercise.
Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.
Training ladder for: LUMBAGO (INSUFFICIENTIA DORSI)
STEP 2
Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.
Unlimited: Cycling. Swimming. Light jogging on a soft surface.
(15 min)
Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.
Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.
Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back with one leg over the other, and hold behind the lower leg’s knee. Draw the leg up towards your head so that the buttock on the upper leg becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back and draw your knee up towards your head while lifting your head so that your back becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.
(5 min)
Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.
Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.
(40 min)
Go down on all fours. Alternately lift and stretch the right and left legs, fully stretching the knee.
Lie on your stomach across a chair with both feet supported under a tabletop. Lift both hands from the floor and hold the position for 2 seconds. Support with your hands for 2 seconds and repeat the exercise 10 times in quick succession.
Lie on your stomach on the floor with your arms above your head and with outstretched legs. Lift right arm and left leg together, changing to lift left arm and right leg together.
Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.
Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.
Sit on a chair with a broom handle behind your back as shown in the sketch. Rotate from side to side at a steady pace.
Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.
Lie on your back with your hands on your chest. Bend your knees and lift your upper body up from the floor while keeping the small of your back against the floor the whole time.
Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.
Training ladder for: LUMBAGO (INSUFFICIENTIA DORSI)
STEP 1
Instruction from the physiotherapist in correct back posture (ergonomic guidance) is important.
The indications of time after stretching, coordination training and strength training show the division of time for the respective type of training when training for a period of one hour. The time indications are therefore not a definition of the daily training needs, as the daily training is determined on an individual basis.
Unlimited: Cycling with raised saddle. Swimming.
(15 min)
Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.
Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.
Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your back with one leg over the other, and hold behind the lower leg’s knee. Draw the leg up towards your head so that the buttock on the upper leg becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.
Lie on your stomach. Rise up and support yourself on your elbows keeping your hip against the floor. Hold the position for 20 seconds. Rest for 20 seconds before repeating.
(5 min)
Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.
Lie on the floor on a cushion. Bend your knees. Lift your hands from the floor and keep your balance.
(40 min)
Sit on a chair with slightly curved back. Thrust your stomach forward and hold the sway-backed position.
Lie on your stomach across a table or chair and support with both arms on the floor. Raise one arm from the floor and hold the position for approx. 10 seconds. Change arm.
Sit on a chair with a broom handle behind your back as shown in the sketch. Rotate from side to side at a steady pace.
Lie on your back with knees bent and arms stretched out to your sides. Keeping your feet together, move your knees alternately right and left while looking in the opposite directions.
Stand with your side against a wall. Support with your shoulder against the wall and press your hip in to the wall for 10 seconds. Rest for 10 seconds before repeating.
Lie on your stomach with both arms above your head. Lift your upper body.
Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.
The etiology, radiographic classification, and treatment of Legg-Calve-Perthes’ disease remain controversial. Several recent papers focus on these issues in an effort to provide guidance in the clinical care of Perthes’ disease. The research studied in this paper lends further support to the hypothesis of clotting abnormalities with vascular thrombosis, which seems to be the most likely etiology for Legg-Calve-Perthes’ disease. Several studies focus on use of magnetic resonance imaging for the early diagnosis and prognosis of Perthes’ disease. A few researchers whose work is featured in this paper add information on the treatment of Perthes’ disease, supporting surgical treatment for older patients with more severe disease and non-surgical treatment for younger patients with less extensive femoral head involvement.
Slipped capital femoral epiphysis remains a diagnostic problem despite numerous papers written on the subject. The most important factor in the diagnosis of slipped capital femoral epiphysis is suspicion by the practitioner. The history, physical examination, and radiographic imaging are important in the confirmation of the diagnosis. Imaging is the topic of 1998 with advances in the areas of ultrasound. Ultrasound may be better in experienced hands than plain radiography in the diagnosis of slipped capital femoral epiphysis. Magnetic resonance imaging is used for diagnosis of slipped capital femoral epiphysis and in the assessment of pre-slips. The magnetic resonance image can be oriented to a plane orthoganol to the plane of the physis to assess the width of the physis and to detect edema in the area of the physis.
