Mechanically Unresponsive Radiculopathy
Definition[edit | edit source]
A Mechanically Unresponsive Radiculopathy (MUR) is a classification in the McKenzie Method or Mechanical Diagnosis and Therapy (MDT) for radicular symptoms from a nerve root compression, however, are unresponsive to treatment.
Presentation[edit | edit source]
The hallmark of an MUR, is that the symptoms remain either unchanged or worse with movement and no position can provide lasting relief. The symptoms will be in a radicular pattern in either the upper or lower extremity. The symptoms will commonly be constant in nature but overall unchanging. Most activities will aggravate the symptoms with no activity or position providing relief beyond a temporary decrease.
Treatment[edit | edit source]
If suspected of an MUR after fully assessing over several visits, a short bout (1-3 weeks) of relative rest and medication may help in reducing pain. The initial 2-3 months can be the worst of the symptoms. Patient are encouraged to follow a program of general exercise and to remain active to maintain function. Often, after this period, patients may respond mechanically to repeated movements or positions. Surgery can be considered if the patient fails conservative treatment. This length of time can vary.
Research[edit | edit source]
Hans van Helvoirt et al. looked at patients with disc herniations who were still experiencing leg symptoms. 69 participants received a transforaminal epidural steroid injection (TESI) to which 11 had a complete resolution. 32 had less leg pain and centralized with a MDT assessment. 11 had less leg pain but did not centralize with MDT treatment, however, had a 50% satisfaction rate. The remaining 15 patients did not respond to the TESI and underwent surgery. This study found that patients who do not centralize could be classified as an MUR and respond to a TESI. However, if neither conservative treatment nor a TESI provided relief, then surgery was the preferred intervention.
References[edit | edit source]
- van Helvoirt, H., Apeldoorn, A. T., Ostelo, R. W., Knol, D. L., Arts, M. P., Kamper, S. J., & van Tulder, M. W. (2014). Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation. Pain Medicine, 15(7), 1100-1108.