post operative lumber disc prolapse!!!

[junior_physiotherapist]

Hi junior physiotherapist, Firstly when I spoke of Mckenzie techniques, I spoke of it in terms of cervical spine. If stabilising the lumbar spine does not help, then mckenzie the cervical spine. First tackling the sagittal plane, then if neccessary the frontal plane. Retraction in unloaded position would be, if you make the pt. lie supine, neck in neutral, & ask the pt. to press down on the couch. Mind it , it is not chin tuck. This procedure can also be done by you by getting the head of the pt. out of the manual therapy table, head stabilised well in your hand.You can progress to retraction in loaded position. its difficult to tell you how to retract online. if you have any Mckenzie trained therapist near you, they could probably show it you. If the sagittal plane does not work, you have to explore the frontal plane, which would include the lateral flexion & rotations.
Your query about core muscles, they are all about training the transversalis reflex back. get the patient to work on stabilizers. these include the transversalis, multifidus,obliques-- all those which are high in isometrics & endurance. Avoid doing these in supine position initially, as these could stress the lumbar level. In this pt. avoid doing these exs on the ball. Once any one has a back problem, the bad news is that the transversalis reflex is lost & it has to be build back. building up the core would take anywhere between 6weeks to 6 months of regular Exs.

Hi asha

Firstly thanks for Very appreciated response
u told me that i have to put pt. in sagittal plane then if not possiple in frontal
,So my question is would u plz explain this for us,(as i mean u want to make movments which occur in sagittal and in frontal plane ??


Regards

[alophysio]

Hi,

A couple of things.

1. The discs in the cervical spine are not fluid filled from the second to third decade onwards so don't expect a reduction via repeated movements ala Mackenzie

2. This lady has YELLOW FLAG written all over her. She is a chronic pain patient. She needs activity, not pain relief via passive treatment. She can put a hot pack and TENS on at home. Get her active.

3. A pain clinic may be of use to her.

4. Her pain may be centrally mediated and physiotherapy / manual therapy not appropriate for her.

5. Any activity sounds like it would be good for this woman

I really think an evaluation by a pain psych is going to be in order. Maybe check to see that there is no pathoanatomical reason for her pain but it is persistent pain so centrally-mediated mechanisms are likely to be in play.

For Yellow flag assessments and the OMPQ, look up this reference of how we do things in NSW Australia...Look up Appendices if you want a short cut!

Lastly, there is significant amounts of research that shows an active approach to chronic pain is the most appropriate treatment - cut the passive stuff out and improve her walking from 14mins to 40 mins over time.

Hope this helps

[asha]

Sorry junior physiotherapist for getting back to you so late. Lost this thread somehow. Side bend & rotations are said to be same movements in different planes in c spine. When you check out the saggital plane the movement testing done is - retraction, retraction with extension, & protrusion. The interpretations would lead you to upper C spine or lower C spine. For frontal plane in unloaded position, sidebent would be difficult to assess if head is on the table. hence check the rotation. While the patient is loaded that is in sitting the frontal plane movements of sidebend & rotations could be assessed. This again leads you to either Upper C spine or lower C spine.
Mckenzie is not only for disc lesions, nor is it only extension. If the patient is a yellow flags candidate, they will surely score high on the questionaire. It is unlikely in this patient. I would prefer to repeat that the cervical symptoms would most likely be due to poor stabilization of her back. A cervical assesment could however be done.