Dear Dr. Sood,
I'd like to know the following things:
Does she have any peripheral symptom, e.g. remaining paresthesia, that can
serve as feedback? That might give you the clue. Without that feedback, it's
very difficult to determine whether to go for an extension or a flexion
approach.
How are her lumbar ROMs? Any end range pain? (Don't try repeated movements
as of yet).
What exactly did the MRI show? Was that a reversible protrusion,
irreversible protrusion or a sequestration? Too determine this, imagine a
tennisball with a marble inside. If the marble is out of the tennisball for
maximally half of its own diameter, then it's reversible. If its out for
more than half of its own diameter, then it's irreversible [one could say
that the disc then closes again after the nucleus (part) has been driven
out]. If it's come loose of the disc, it's (of course) a sequestration.
If this all doesn't provide clear clues, I'd go for extension. Because she's
too young to have an osteophytical stenosis, and she's obviously susceptible
to disc derangement, which might give her more problems (on another level,
or maybe even on the same) than she's already got. Furthermore, because
it's clear that bad disc conditions will cause problems in later life, even
without them deranging )formation of osteophytes, to name one). See
Magnusson et al, Spine 1996 November;21(22):2670-2675,
http://ipsapp002.lwwonline.com/servlet/GetFileServlet?
J=1140&I=93&A=17&U=1&T=0
on how extension can resore disc height; not that I'd recommend sustained
extension in this case, but this is merely for the Physio list members.
Lastly, because sooner or later she's gonna make that extension movement.
Better do it now, under controlled circumstances. Do keep in mind though
that at this point in time exactly this extension could make an irreversible
protrusion into a sequestration. The protrusion might need more time time to
dry out/be resorbed.....
That's why I'd want to see, or know the results of, a clear MRI.
Tough question, you asked! But I hope this still helps.
(I'd like to see which direction will produce improvement or worsening
before I'd start trunk muscle training or neural flossing, in answer to
Bruce's note on the Physio list.)
R.,
Frank
----- Original Message -----
From: "Dr. S.C. Sood" <[log in to unmask]>
To: <[log in to unmask]>; "- for physiotherapists in education
and practice" <[log in to unmask]>; "Frank Conijn" <[log in to unmask]>
Sent: zondag 26 augustus 2001 19:45
Subject: [McKenzieStudy] back pain & disc prolapse.
Dear Frank Conijn,
I am surprised and impressed about deep insight
you have about back pain problems and hence always
value your opinion,In this case foot drop is 6 months old and partial
.What I am wondering is let us for some time forget that she has no pain
,if we wish to try Mechanical therapy in this case will you recommend
Extension or flexion principal for the reduction of root compression by
disc.Along with this I am also trying lumbar traction .As she is not willing
for surgery we can not say nothing is possible.Shall we can try the
decompression of nerve roots by EIL or widening of canal by flexion of
lumbar spine if you have to choose which on you will go for.....
Thanking you,
Dr.Sarveshwar Sood,
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