Indications, Precautions, And Contraindications For Interventions—Extension Approach

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on November 20th 2008

Indications. Extension is used if pain and/or neurological symptoms centralize (decrease of move more proximally) during extension testing maneuvers and peripheralize (worsen) during flexion. Extension is also indicated for flexed postural dysfunctions with limited range into extension.

Contraindications to Specific Spinal Movements

Extension of the spine is contraindicated

• When no position or movement decreases or centralizes the described pain
• When saddle anesthesia and/or bladder weakness is present (could indicate spinal cord or cauda equina lesion)
• When a patient is in such extreme pain that he or she rigidly holds the body immobile with any attempted correction
Flexion of the spine should be avoided:
• When extension relieves the symptoms
• When flexion movements increase the pain or peripheralize the symptoms

PRECAUTION: A patient with acute pain in the spinal region that is not influenced by changing the patient’s position or by movement must be screened by a physician for signs of serious pathology.

CONTRAINDICATIONS: When there is a disk lesion, any form of exercise or activity that increases intradiskal pressure, such as the Valsalva maneuver, active pelvic tilt, or trunk-raising exercises, is contraindicated during the protection phase of treatment. Any movement that peripheralizes the symptoms signals a movement that is contraindicated during the acute and early subacute period of treatment. Peripheralization with extension motions may indicate stenosis, a large lateral disk protrusion, or pathology in a posterior element.

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Filed Under: Physical Therapy, cheng
Tags: anesthesia, bladder, intradiskal pressure, pain, spinal cord, symptoms

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