Herniated disc: physical therapist
viewpoint
Referral to a physical therapist for a herniated
disc
A patient with pathology as described in this case may not be referred to physical
therapy, but instead be referred directly to a spine surgeon. Once the surgeon
assessed the extent of the pathology and discussed options for care with the
patient, physical therapy might be one of the options.
Physical therapy techniques for a herniated
disc
If the patient were referred for physical therapy for treatment of a herniated
disc, it would be very important for the therapist to watch closely and be
sure the neurologic signs did not worsen. Motor and sensory reassessments can
be done on each visit to be sure losses do not occur. The therapy would be
focused on identifying and utilizing positions and movements that decreased
the leg pain. The patient with the herniated disc may respond well to a McKenzie
approach for therapy, that is, seeing if the pain centralized, or diminished
in the leg and moved into the back with certain movements and positions. If
the pain can be centralized, reinforcing these positions with support and repeated
training may alleviate the problem. However, if the leg pain cannot be influenced
by movement or position, therapy should be discontinued within just a few visits.
Other treatments for a herniated disc
With the given pathology, therapy alone may not be effective, and other interventions
may be needed to treat the herniated disc. However, whether the resolution
of the symptoms occurs with or without other interventions, therapy is crucial
for corrective measures once symptoms are gone. Creating muscular stabilization
in the lumbar spine is key for protecting the back once the pathology is
controlled. Specific muscle recruitment for protecting the back must be learned
and repeated to the extent that the muscular protection can become automatic
with different activities and postures. The therapist will work with the
patient to restore optimal movement and posture with stabilizing muscle control.
By:
Carol M. McFarland, MS, PT, OCS
September 14, 2000 |
|
