ETIOLOGY:
In addition to pain from inflammatory products and reflex spasm, a
bulging disc may insult structures in and around the nerve roots or the root itself. In the presence of soft neurologic signs such as paresthesia (numbness or tingling), hyper- or hypoesthesia (increased/ decreased sense of touch), and pain radiation along a radicular distribution, a variety of chiropractic approaches are appropriate for a clinical trial.
APPROPRIATE CARE:
Myofascial soft tissue work, flexion distraction and
adjusting, along with a home regimen of exercises will reduce spasm and increase ROM.
EXPECTED FREQUENCY AND DURATION OF CARE:
The degree of annular bulging,
healing requires a greater amount of time than non-disc injuries because of the avascular (no blood supply) nature of disc tissue. This condition is treated in similar fashion to disc conditions without radicular findings: however, neurologic involvement may contribute to additional spasm and may slow response to care. Care is usually of several months duration with initial frequency at 3 or more sessions per week, gradually reducing to PRN frequencies of 1 per month to discharge.
TOTAL: 26-30 sessions over 5-6 months.
|
WEEK |
CARE |
PROGRESS |
M |
T |
W |
T |
F |
S |
|
1 |
Pain relief (ice)
Myofascial work |
Gradual relief of muscle spasm and
some pain reduction
3-5 /week |
X |
|
X |
|
X |
|
|
2-4 |
Myofascial work
Adjusting/ flexion distraction
Home exercise |
>50% subjective pain relief
>50% improved ROM
Decrease in pain distribution
2-3 /week |
|
X |
|
X |
|
|
|
5-16 |
Adjusting
Myofascial work
Home strengthening exercise |
Gradual progressive improvement with
resolution
PRN follow-ups
1-2 / week |
|
|
X |
|
|
|
PRN = per required need (patient
request)
ATTENUATING FACTORS: The nature of the symptoms, the degree of the initial disc injury, general
metabolic health and compliance with home exercise plan all contribute to recovery time.
Return to the "Low Back Pain" Guidelines Section
