Quote Originally Posted by jacinta View Post
hello mohan,

his iliopsoas tighthness had been relieved since previous visit
SIJ mobility is good(tested in std -> trunk fwd flx & alt. hip/kn. flx); only produce localized pain on LT SIJ in the position prescribe previously, & on overpressure

hi sdkashif,

all 3 tests are -ve
we suggested a MRI.
result shown that he had a disc protrusion more to the left of L5/S1
pt is now seen for backpain rehab instead of sport rehab.

smthg that i do not understd,
why would all neurodynamics tested -ve?
eager to hear explaination from any guru out there.

thanks
This is easy to say now that i'm tagging onto the end of the discussion, but a thorough testing for Lumbar Posterior Derangment would have been top of my list - along with the local gluteal assesment- even from the subjective history, distribution of pain (despite the direction the clients feels the pain radiates in) and mechanism of injury.

Referred pain above the knee does not require direct neural compression / irritation or involvment as the outer layers of the Lx disc's annulus are known to be a powerful source of somatic referred pain. Neurodynamics can be normal in this case (and often is!)

The only way to thoroughly definatively test for Lumbar disc involvement would be the use of repeated movements. Palpatory methods on the spine and examining movement in fx ex rotn lat flexion only once or twice in each directtion will not always reveal an effect on referred pain from the disc as a source- likely because of the biomechanics of the intevertebral disc. to exclude the Disc as a source of pain, we MUST use repeated movements (we're talking 5 to 10, someites 20 repetitions, looking for change in referred symptoms: patterns of peripheralisation, centralisation, worsening intensity, abolishing symptoms, changes in range etc.)

Can i suggest that you read up on the McKenzie method of Mechanical Diagnosis and Therapy? And really get into the detail of the concepts. It is used poorly by many physios but is an incredibly useful frame-work to build Lumbar spine assessment around. It's incredible how much of what we are trying to treat peripherally is really coming from a central / spinal source

McKenzie ("MDT") has changed the way i practice.

BTW, this diagnosis is not any more difficult to treat than all of the others - people often equate disc problems with something quite incurable. Again - Mckenzie works brilliantly in this case

Cheers