BCP Lumbar Disc Pathology

Question 1

What’s the difference between Radicular pain and Radiculopathy?

Answer 1

• Radicular pain is pain that follows the nerve pass and is just pain.
• Radiculopathy is nerve function, this can include pain but it also addresses strength, sensation, reflexes.

Question 2

At what 2 levels do the most common disc herniations occur?

Answer 2

• L4/L5
• L5/S1

Question 3

Name two disc pathologies besides bulges and herniations

Answer 3

• Annular tears: Tears to the outer Annulus fibres
• Schmorls Nodes; Nucleus extrusions into the vertebral body

Question 4

what is the difference between a disc herniation and bulge?

Answer 4

• Bulge’s are smaller, disc tissue extends less than 25%
• Herniation’s are larger, disc tissue extends greater than 25%

Question 5

What is the difference between contained and uncontained herniations?

Answer 5

• Uncontained means the herniation has extended past the Posterior longitudinal ligament, whereas contained means it hasn’t

Question 6

Why is an uncontained herniation more likeley to resolve than a contained herniation?

Answer 6

• When it is uncontained it breaches the spine and is exposed to the immune system thus heals better.

Question 7

what are the three types of Disc herniation?

Answer 7

Protrusion - the extruded material is thicker at the base
Extrusion - the extruded material is thicker at the head.
Sequestration - Extruded material detached from the disc

Question 8

What are the signs and symptoms of disc herniation/bulging

Answer 8

• back pain
• radiating leg pain worse than back
• dermatome distribution of pain
• parathesia
• burning, sharp, shooting pain.

Question 9

What would we look out for in our observation of a client with suspected Disc pathology?

Answer 9

• lateral flexion (hip out to one side)
• walking in trunk flexion
• limping to try and not weight bear

Question 10

What special tests would we use?

Answer 10

• SLR
• cross leg sign
• sign of the buttock (flex the knee to de-stress the nerve, if still painful increased likely hood)

Question 11

What is the Handcock rule for Lumbar Disc pathology

Answer 11

It’s likely a disc pathology if 3/4 are present
- Follows Myotomal pattern
- Sensory loss (Dermatomal pattern)
- location (LB pain, worse leg pain)
- reflex response

Question 12

What three surgical options are available for Disc Pathologies?

Answer 12

• Disectomy
• Laminectomy
• Fusion

Question 13

When might we opt for an Epidural injection over surgery for Disc pathology? And why would we select them?

Answer 13

• if they have Radiculopathy and high pain but no significant Myotome deficiency. The hope is the injection removes pain while disc heals slightly and improved

Question 14

When would you use specific vs non specific exercise for a lumbar disc pathology?

Answer 14

• non specific and lower insists can be used when they are hyper painful and irritable.
• more specific exercise should be done later when pain is managed

Question 15

What is the average recovery time from Sciatica?

Answer 15

4-12 months

Question 16

What Rehabilitation exercises would we use for an early/irritable disc pathology/Sciatica?

Answer 16

Neural slide and glides such as:

• Lateral glides (only if presenting with lateral pelvic shift) leaning against wall and push pelvis towards wall.
• Graded exposure Slump test (move through motions; slump then add chin to chest, then add leg extension)
• lying heel slides (glides nerve) add anterior or posterior pelvic tilt within pain limits
• graded exposure prone lumbar extension.

Question 17

What would we do for for early movements for the lumbar disc pathology/Sciatica after irritation has calmed down? (STAGE 2)

Answer 17

Kneeling and rolling exercises such as:

• Quadruped rocking,
• Rocking child’s pose
• Thread the needle
• cat camel pelvic tilts
• Bird Dog alternations
• knee rolling (extend leg as progression)
  -knee hugs
• crunches (add directional eg bicycle crunch)

Question 18

What exercises would we ask suspected disc pathology/ sciatica to do in standing? (Stage 3)

Answer 18

• standing flexion graded exposure (hands to middle, to one side, chin to chest then flex)
• standing extension

-Jefferson curl (KB flexion)

-KB past around waist and figure 8 through leg

-KB deadlift with focus on hip hinge over LX flexion

Question 19

What exercises would we give someone with suspected Disc Pathology/sciatica at a late stage (Stage4)

Answer 19

Core stability (planks & chops) such as:

• prone hyper extensions (change difficulty by varying arm placement)

-plank variations

• wood chopper variations

Question 20

What is a great non-specific exercise for Disc pathologies/Sciatica?

Answer 20

Walking