CARE PLAN 9: PROBABLE DISCOGENIC INVOLVEMENT WITHOUT NEUROLOGIC SIGNS
 
   

Care Plan 9:   Probable Discogenic Involvement
Without Neurologic Signs

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:
   Frankp@chiro.org
 
   

ETIOLOGY: Disc protrusion may produce pain from inflammatory products at the disc itself. It may also produce reflex spasm and resultant pain. This condition usually arises from lifting and loading while rotating at the waist.

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. 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: 24-28 sessions over 5 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

 

 

 



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.


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