CARE PLAN 10: PROBABLE DISCOGENIC INVOLVEMENT WITH SOFT NEUROLOGIC SIGNS
 
   

Care Plan 10:   Probable Discogenic Involvement
With Soft Neurologic Signs

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

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.

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