Herniated Disc: Physical Therapist Viewpoint
Referral to a Physical Therapist for a Herniated Disc
A patient with pathology as described in this case may not be referred to physical therapy, but instead be referred directly to a spine surgeon. Once the surgeon assessed the extent of the pathology and discussed options for care with the patient, physical therapy might be one of the options.
Physical Therapy Techniques for a Herniated Disc
If the patient were referred for physical therapy for treatment of a herniated disc, it would be very important for the therapist to watch closely and be sure the neurological signs did not worsen. Motor and sensory reassessments can be done on each visit to be sure losses do not occur. The therapy would be focused on identifying and utilizing positions and movements that decreased the leg pain. The patient with the herniated disc may respond well to a McKenzie approach for therapy, that is, seeing if the pain centralized, or diminished in the leg and moved into the back with certain movements and positions. If the pain can be centralized, reinforcing these positions with support and repeated training may alleviate the problem. However, if the leg pain cannot be influenced by movement or position, therapy should be discontinued within just a few visits.
Other Treatments for a Herniated Disc
With the given pathology, therapy alone may not be effective, and other interventions may be needed to treat the herniated disc. However, whether the resolution of the symptoms occurs with or without other interventions, therapy is crucial for corrective measures once symptoms are gone. Creating muscular stabilization in the lumbar spine is key for protecting the back once the pathology is controlled. Specific muscle recruitment for protecting the back must be learned and repeated to the extent that the muscular protection can become automatic with different activities and postures. The therapist will work with the patient to restore optimal movement and posture with stabilizing muscle control.
