Lumbar Deranged Disc

Question 1

What are the clues for a disc derangement?

Answer 1

• Sx centralization with repetitive/sustained loading
• Decreased sagittal thoracolumbar ROM
• Positive Valsalva
• Sitting poorly tolerated
• DeJerine’s triad
• Pattern of flexion load sensitivity
• Sensitive to axial loading (e.g., dSLR)

Question 2

What are negative clues for disc derangment?

Answer 2

Negative tension tests,

no neuro signs

Question 3

What are some things you might observe that supports a disc derangement?

Answer 3

• flexion (kyphotic) antalgia
• extension (lordotic) antalgia
• arterial pelvic shift

Question 4

When should you fix a anataLgic posture for disc derangement?

Answer 4

• before the physical or within the first visit

Question 5

Explain flexion anatalgia for a disc derangemnt?

Answer 5

Sometimes a “sweet spot” where the acutely inflamed posterior disc is unloaded, but without being tensioned by too much flexion. Further flexion is pain provoking. Often repetitive or sustained extension into the painful block is therapeutic.

Question 6

Explain extension antalgia for a disc derangment?

Answer 6

Less commonly, the patient may stand so that the inflamed anterior disc is unloaded.
Often repetitive or sustained flexion into the painful block is therapeutic.

Question 7

What does positive minors sign indicate?

Answer 7

• lumbar instability
• deranged disc
  Etc.

Question 8

What are four key points of centralization?

Answer 8

1. Multiple directions need to be explored.
2. Extension is the therapeutic direction perhaps 60-70% of the time.
3. The loads may be done actively by the patient alone or with overpressure supplied by the practitioner.
4. If centralization does not occur, sometimes a directional (therapeutic) preference is found because the intensity of the symptoms decrease or AROM improves.

Question 9

How do you know you found a pain centralizing direction? (3)

Answer 9

1. The pain centralizes (i.e., the distal territory shrinks), although local or proximal pain may increase.
   Examples:
   o LBP radiating to the foot now radiates only to the knee or
   buttock
   o leg pain/paresthesia with no back pain becomes back pain with no leg symptoms
   o an area of LBP 4 inches wide narrows to 2 inches toward the center of the spine.
2. The distal symptoms may decrease in intensity, although
   local and proximal pain may increase.
3. Symptoms may not improve, but active range of motion improves.

Question 10

When looking for a level and vector to manipulate the patient, one option is to look for… (2)

Answer 10

1. A level or vector that causes pain centralization

2. A segment and level that is most tolerated by the patient

Question 11

If you suspect a deranged disc, what ancillary studies do you order?

Answer 11

None, you do not need it (at least at first)