LUMBAR disc herniation

Question 1

similar DDX’s

Answer 1

• lumbar facet syndrome
• piriformis syndrome
• lumbar sprain/strain

Question 1

LUMBAR disc herniation classic presentation

Answer 1

• young male with previous episodes of back pain
• pain with bending and twisting
• sharp constant pain and catching on movements
• radiating pain past the knee
• antalgic lean and limping gait

Question 2

supporting factors

Answer 2

• dec. ROM
• traumatic onset
• age b/w 18-40
• better when lying supine and on side
• constant pain worse in the mornings
• pain arising from chairs

Question 3

refuting factors

Answer 3

• pain and paresthesia only above knee
• older patient
• insidious onset
• bilateral symptoms
• UMN symptoms

Question 4

relevant orthos

Answer 4

• minors sign
• Neri’s test
• seated kemp’s
• valsalva’s
• straight leg raise test (and siccards braggards and bowstrings)

Question 5

referrals

Answer 5

• lumbar x rays
• MRI
• GP

Question 6

contraindications

Answer 6

• adjust to patient tolerance

Question 7

technique

Answer 7

• avoid rotation/torque in lumbar spine

Question 8

care plan

Answer 8

2 x a week for 4 weeks

Question 9

recommendations

Answer 9

• hydration
• stay mobile
• no smoking or drinking

Question 10

prognosis

Answer 10

• 3 months to heal if non smoke
• 9-18 months if smoker