exer rehab question

[Guest guest]

HI everyone

I have had several patients with diagnoses of paracentral disc protrusion with displacement of an adjacent nerve root. The disc is protruding post-lateral and either minimally or significantly causing indenting of the nerve root, thecal sac or in more severe cases, the spinal cord. When the patient hyper-extends the lumbar spine, the pain/paresthesias increase.

Many of the PTs seeing my patients (they're sent by their PCP) are having the patient do prone hyper-extension exercises. They have the patient lay on their belly and lift the upper body up, holding it for up to 5 min. Or lift up on a large pillow (under the chest) to accentuate the lumbar lordosis. Patients complain that this aggravates their condition. But the PTs claim that it's good for the disc injury????!!

Is there something I don't know about this condition that would make it wise to have patients hyperextend? So many PTs do this that I'm beginning to wonder.

thanks,

Minga Guerrero DC

Gresham OR

[Guest guest]

The god McKenzie spoke and the people heard the words, but did not listen... Sometimes extension is good.. Sometimes Flexion is good... Provocation and exacerbation of presenting symptoms is never good (except diagnostically!) The problem isn't the hyperextesnion, it is the lack of thought process utilized by these technicians! The good PT's think and customize the exercise to the patient, not force the patient to conform to a rigid protocol. (The same process applies to Chiropractic!) I believe the key is neutral spine stabilization in pain free-range, but that is just my opinion.

Seitz, DC Tuality Physicians

730-D SE Oak St

Hillsboro, OR 97123

(503)640-3724 >From: AboWoman@... > >Subject: exer rehab question >Date: Thu, 4 Nov 2004 18:58:25 EST > >HI everyone >I have had several patients with diagnoses of paracentral disc protrusion >with displacement of an adjacent nerve root. The disc is protruding post-lateral >and either minimally or significantly causing indenting of the nerve root, >thecal sac or in more severe cases, the spinal cord. When the patient >hyper-extends the lumbar spine, the pain/paresthesias increase. > >Many of the PTs seeing my patients (they're sent by their PCP) are having the >patient do prone hyper-extension exercises. They have the patient lay on >their belly and lift the upper body up, holding it for up to 5 min. Or lift up on >a large pillow (under the chest) to accentuate the lumbar lordosis. Patients >complain that this aggravates their condition. But the PTs claim that it's good >for the disc injury????!! > >Is there something I don't know about this condition that would make it wise >to have patients hyperextend? So many PTs do this that I'm beginning to >wonder. >thanks, >Minga Guerrero DC >Gresham OR

[Guest guest]

Minga,

Ditto on 's remarks. MacKenzie protocol requires thoughtful assessment of bias (positions which centralize the leg pain) before starting treatment. Any positions that worsen leg pain should be avoided. Patient is counselled that frequently, as the leg pain centralizes, the back pain will increase. If they don't get that prep, they may think " Great! The #$#@%$ fixed the leg, but now my back's killing me!" Sounds like you have gotten a run on PTs who fell asleep during the first part of the MacKenzie lectures.

PLEASE NOTE NEW ADDRESS!

W. Snell, D.C. 3343 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956>From: "BRIAN SEITZ" <dcdocbrian@...> > >Subject: RE: exer rehab question >Date: Thu, 04 Nov 2004 16:10:58 -0800 >

The god McKenzie spoke and the people heard the words, but did not listen... Sometimes extension is good.. Sometimes Flexion is good... Provocation and exacerbation of presenting symptoms is never good (except diagnostically!) The problem isn't the hyperextesnion, it is the lack of thought process utilized by these technicians! The good PT's think and customize the exercise to the patient, not force the patient to conform to a rigid protocol. (The same process applies to Chiropractic!) I believe the key is neutral spine stabilization in pain free-range, but that is just my opinion.

Seitz, DC Tuality Physicians

730-D SE Oak St

Hillsboro, OR 97123

(503)640-3724 >From: AboWoman@... > >Subject: exer rehab question >Date: Thu, 4 Nov 2004 18:58:25 EST > >HI everyone >I have had several patients with diagnoses of paracentral disc protrusion >with displacement of an adjacent nerve root. The disc is protruding post-lateral >and either minimally or significantly causing indenting of the nerve root, >thecal sac or in more severe cases, the spinal cord. When the patient >hyper-extends the lumbar spine, the pain/paresthesias increase. > >Many of the PTs seeing my patients (they're sent by their PCP) are having the >patient do prone hyper-extension exercises. They have the patient lay on >their belly and lift the upper body up, holding it for up to 5 min. Or lift up on >a large pillow (under the chest) to accentuate the lumbar lordosis. Patients >complain that this aggravates their condition. But the PTs claim that it's good >for the disc injury????!! > >Is there something I don't know about this condition that would make it wise >to have patients hyperextend? So many PTs do this that I'm beginning to >wonder. >thanks, >Minga Guerrero DC >Gresham OR

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[Guest guest]

The

McKenzie protocol utilizes sustained/static and or repetitive movements to

evaluate discal response to loading strategies. To give all patients with

paracentral disc herniation static extension or repetitive extension self

treatment measures violates the very basics of the McKenzie evaluation

process. McKenzie after all is primarily an evaluation process and

secondarily a method of treatment. Utilizing McKenzie concept the patient

is only given those self treatment measures or loading strategies that

centralize/reduced the lesion /symptoms. To briefly summarize this process, the

patient is put into static or given a repetitive loading strategy such as

extension. It is then important to note the response to loading strategy

e.g. if the pain is pulled out of the legs into the low back. The goal is

to centralize the pain out of the legs into the low back. This is

typified by a green light phenomena or concept.

GREEN LIGHT: the pain is reduced or

pulled out of the legs into the low back. The low back pain should

gradually become more and more focused/smaller. It is acceptable if the

low back pain becomes more intense as long as it becomes more focused.

Immediately after moving out of the test position (in this example extension)

it is acceptable and expected to have increased low back pain. This pain

however should be significantly better than it was before the test position in

10 to 20 minutes. All of these criteria need to be met in order for green

light phenomena to occur.

This testing strategy goes on

further to detail yellow and red light phenomena which I will not going

into. Based on how the patient responds to these loading strategies both

immediately and as 72 hours progresses, gives solid indicators as to whether

not the pain is derangement, chemical or postural in nature.

That in brief is the process.

This process allows you to have a conversation with the lesion. The

lesion will change as the conversation progresses, or at least it should if you

have a lesion that will respond to mechanical care.

Larry Lubcke DC, DABCO

exer rehab

question

HI everyone

I have had several patients with diagnoses of paracentral disc protrusion with

displacement of an adjacent nerve root. The disc is protruding post-lateral and

either minimally or significantly causing indenting of the nerve root, thecal

sac or in more severe cases, the spinal cord. When the patient

hyper-extends the lumbar spine, the pain/paresthesias increase.

Many of the PTs seeing my patients (they're sent by their PCP) are having the

patient do prone hyper-extension exercises. They have the patient lay on their

belly and lift the upper body up, holding it for up to 5 min. Or lift up on a

large pillow (under the chest) to accentuate the lumbar lordosis. Patients

complain that this aggravates their condition. But the PTs claim that it's good

for the disc injury????!!

Is there something I don't know about this condition that would make it wise to

have patients hyperextend? So many PTs do this that I'm beginning to wonder.

thanks,

Minga Guerrero DC

Gresham OR

OregonDCs

rules:

1. Keep correspondence professional; the purpose

of the listserve is to foster communication and collegiality. No personal

attacks on listserve members will be tolerated.

2. Always sign your e-mails with your first and

last name.

3. The listserve is not secure; your e-mail could

end up anywhere. However, it is against the rules of the listserve to copy,

print, forward, or otherwise distribute correspondence written by another

member without his or her consent, unless all personal identifiers have been

removed.

[Guest guest]

A most excellent explanation/post thanks for taking the time to do so Larry!

Vern Saboe

RE: exer rehab question

The McKenzie protocol utilizes sustained/static and or repetitive movements to evaluate discal response to loading strategies. To give all patients with paracentral disc herniation static extension or repetitive extension self treatment measures violates the very basics of the McKenzie evaluation process. McKenzie after all is primarily an evaluation process and secondarily a method of treatment. Utilizing McKenzie concept the patient is only given those self treatment measures or loading strategies that centralize/reduced the lesion /symptoms. To briefly summarize this process, the patient is put into static or given a repetitive loading strategy such as extension. It is then important to note the response to loading strategy e.g. if the pain is pulled out of the legs into the low back. The goal is to centralize the pain out of the legs into the low back. This is typified by a green light phenomena or concept.

GREEN LIGHT: the pain is reduced or pulled out of the legs into the low back. The low back pain should gradually become more and more focused/smaller. It is acceptable if the low back pain becomes more intense as long as it becomes more focused. Immediately after moving out of the test position (in this example extension) it is acceptable and expected to have increased low back pain. This pain however should be significantly better than it was before the test position in 10 to 20 minutes. All of these criteria need to be met in order for green light phenomena to occur.

This testing strategy goes on further to detail yellow and red light phenomena which I will not going into. Based on how the patient responds to these loading strategies both immediately and as 72 hours progresses, gives solid indicators as to whether not the pain is derangement, chemical or postural in nature.

That in brief is the process. This process allows you to have a conversation with the lesion. The lesion will change as the conversation progresses, or at least it should if you have a lesion that will respond to mechanical care.

Larry Lubcke DC, DABCO

-----Original Message-----From: AboWoman@... [mailto:AboWoman@...] Sent: Thursday, November 04, 2004 3:58 PM Subject: exer rehab question

HI everyoneI have had several patients with diagnoses of paracentral disc protrusion with displacement of an adjacent nerve root. The disc is protruding post-lateral and either minimally or significantly causing indenting of the nerve root, thecal sac or in more severe cases, the spinal cord. When the patient hyper-extends the lumbar spine, the pain/paresthesias increase. Many of the PTs seeing my patients (they're sent by their PCP) are having the patient do prone hyper-extension exercises. They have the patient lay on their belly and lift the upper body up, holding it for up to 5 min. Or lift up on a large pillow (under the chest) to accentuate the lumbar lordosis. Patients complain that this aggravates their condition. But the PTs claim that it's good for the disc injury????!!Is there something I don't know about this condition that would make it wise to have patients hyperextend? So many PTs do this that I'm beginning to wonder.thanks,Minga Guerrero DCGresham OR OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.