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RE: Lumbar disc herniation protocol
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RE: Lumbar disc herniation protocol - April 8, 2008 5:11:42 PM
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Sebastian Asselbergs
Posts: 1105
Joined: September 29, 1999
From: Barrie, Canada
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I prefer calling it "your middle parts" when talking to a patient. For some, I have to capitalize the words....
I tend to refer to any trunk muscle activation as, well......"trunk muscle activation and movement restoration" and mention the all-important nerves to all my patients.
Most seem to get it - some take longer to get rid of the preconceived "slipped discs", "my spine is out", "my vertebra is out of line", "my stomach is weak"- type notions.
In other words, I can honestly say I have no lumbar disc herniation "protocol", other than the general "protocol" I have for all my patients - educate, educate, eduate. (Just like almost all participants on this thread - and that is cool to see)
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RE: Lumbar disc herniation protocol - April 8, 2008 6:28:13 PM
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rwillcott
Posts: 352
Joined: March 20, 2006
From: Canada
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proud,
I understand what you're saying about PT's that have elaborate explanations about reduced joint movements and poor recruitment patterns etc. Your right when you say that some patients buy into this. However, many patients don't fully understand this explanation of their back pain. In my opinion, the patient has to get what you are explaining in order to buy into the treatment plan. If a PT explains the evidence on a level that the patient can understand they will be more likely to trust you.
Also, reagrdless of the 'bunk' that some PT's explain to their patients, their are other areas that trump this approach. Showing professionalism and confidence will always trump the PT's that have crazy explanations of a ERSR of L5/S1. What patient is going to buy ino this? However, if you are someone who understands the literature and believes in it the patient will respond positively.
Recently I had a patient referred to me for LBP. He had a disc herniation that unfortanetly looks like it may require surgery. I performed a thorough lower quadrant scan and lumbar evaluation on the first day. He stated I was the first to perform a full evaluation. No one checked myotomes and noted his foot drop. I was also the first to explain the cause of his weakness and numbness. I din't fart around with this patient and attempt to explain that his piriformis was pinching his sciatic nerve caused by his leg length discrepancy. I explained the cause from my own evidence based understanding on a level he could comprehend.
This patient recently referred his friend to me. His friend asked him why he should see me. His reason was because I seemed very knowledgable and professional. This is an example of how certain characteristics of how we present ourselves will always trump the crap that others dispense to their patients.
Rob
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RE: Lumbar disc herniation protocol - April 8, 2008 6:51:57 PM
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proud
Posts: 873
Joined: March 22, 2006
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Rwillcott,
Professionalism and not stooping to mystical explainations? WOW...it's a concept that just may work....
Honestly, if only all PT's practiced in this manner, perhaps the general public might not be so confused about who we are and what we do.
How many of you have heard this one while treating an approximately 55 year old patient:
" my daughter is studying to do what you do..."
Then you find out that in fact the "daughter" is taking a 6 month massuer course....
Physiotherapists wonder why this happens? It's quite simply what rwillcott just said. Foolish explainations beget a foolish looking trade.
I can only imagine what some patients go back and tell their doctors after a sesion of Tra/multifidus re-training:
Doctor: " ....what's the PT doing for your back pain...."
Patient: " ....Well...he's telling me to suck my testicals up into my belly...something to do with a muscle that's not working right...."
Sounds foolish....is foolish. I think.
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RE: Lumbar disc herniation protocol - April 8, 2008 9:23:11 PM
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rwillcott
Posts: 352
Joined: March 20, 2006
From: Canada
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Good points. I try to explain to people that we are the only health professionals that treat injury who have a university education. I wish the CPA and APTA would do a better job getting this across to the public.
All we can do is offer a thorough evaluation and evidence based treatment approach to all patients. We can never waiver and let our guard down. We must becone relentless in our battle to seize control of our rightful home at the top of the NMSK rehabilitation mountain. People recognize the gold standard when they see it. If enough of us continue to perform a great job, word will spread! I have to believe this. I beleive in what I do and will never accept some half-assed group taing a piece of what I know I am the best at.
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RE: Lumbar disc herniation protocol - April 9, 2008 11:02:39 AM
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rwillcott
Posts: 352
Joined: March 20, 2006
From: Canada
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I like using the stability exercises recommended by Stuart McGill for some patients (front plank, birddog, side bridge, crunch). Not because I think they are the optimal exercises to stabilize the spine. I recommend them since I feel that the patient understands and feels how they could be important. They also are more 'mainstream' and give the impression that I understand health and fitness. As proud said we don't want the patient going back to their doctor describing a testicle pulling exercise with visualiation of the gonads going through an imaginary cylinder. If the pateint describes a bridging and birddog exercise the doctor will be happy to see their patient is becoming active in some way. Again, I don't prescribe these to everyone.
However, I almost always prescribe these to an athlete or someone who is active. Most times they have seen or read about these exercises (Men's Health, Runner's World etc.) and are optimistic about learning from a professional how to perform them properly. They can then show off to their friends and teammates their new 'specific' back exercises that their physiotherapist prescribed. Not too many atheletes want to show-off the testicle maneuver!
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RE: Lumbar disc herniation protocol - April 10, 2008 7:54:53 AM
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buckeye
Posts: 147
Joined: May 24, 2007
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I do not think anyone mentioned traction or spinal decompression treatment. I still get a few referrals specifically asking for lumbar traction. Any thoughts? Most of the time the lumbar traction table gathers dust.
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RE: Lumbar disc herniation protocol - April 10, 2008 8:56:17 AM
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rwillcott
Posts: 352
Joined: March 20, 2006
From: Canada
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SJbird 55,
We're a bit weird up her in Canada. The reference to testicles stems from the work of a Canadian PT named Rick Jemmett. He has a text called 'Spinal Stabilization-The New Science of Back Pain'. In it he describes different ways to cue the patient to recruit their TrA. One is to have the patient imagine that their testicles are in a cylinder and to imagine pulling them up through the cylinder. Another is to imagine you are walking into ice cold water and you are pulling the 'boys' up to avoid the cold water.
If I do recommend TrA work I simply advice the patient to draw the belly button in and towards the bed.
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RE: Lumbar disc herniation protocol - April 10, 2008 8:56:30 AM
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jlharris
Posts: 468
Joined: April 12, 2006
From: Nebraska
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I do occasionally use lumbar traction. I attempt manual ditraction with anyone experiencing radicular pain. And then if the MD ordered it, the patient requests it, or it seems they would benefit from more than I can provide w/o fatiguing, I'll toss them in at the end of treatment.
I tend to look at it like ice or heat...something that can be done to decrease (or percieve to decrease) LE sx's in the short term after MT and ther ex that has been shown to decrease/eliminate their sx's in the long term.
As a reference, I used lumbar traction on 4 patients last year. Very small percentage of my LBP pt's but still was used.
As a side note, we have a DO practice in town that hires PT's to run their DRX 9000 and they push spinal decompression hard. Obviously all their LBP pt's go there, and it seems other doctors are falling for the "cutting edge" treatment claims and sending pt's there to. I get questions about it regularly from patients and I probably have 20+ comments on my little blog from my post on the DRX 9000. This is discouraging at times. Talk about cookie-cutter PT (and it's a stretch to call putting someone in traction daily for 6 weeks "physical therapy")
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Jason L. Harris, PT, DPT
My PT Blog
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RE: Lumbar disc herniation protocol - April 12, 2008 9:30:59 AM
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dscouras
Posts: 27
Joined: January 27, 2007
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Traction I mean DRX 9000, cutting edge technology that heals. Funny I was on holidays a couple years ago and talking with a chiropractor about back pain and he mentioned that the found this new and amazing technique that treats back pain.
I asked what his treatment consisted of and he said exactly what you mentioned above. 4-6 weeks of traction 3x/wk and by the end of it most clients were cured of their pain. I guess the ability to play video games while being tractioned is of psychological benefit.
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