Lumbar Radiculopathy Treatment: Difference between revisions
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=== Repeated Movements === | === Repeated Movements === | ||
The use of repeated movements is a hallmark of the [[McKenzie Method]] or MDT (Mechanical Diagnosis and Therapy). When utilizing repeated movements, the goal is to determine a [https://www.physio-pedia.com/Directional_Preference?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal directional preference], which is the [[centralization]] of the symptoms. | |||
=== Education === | === Education === | ||
Revision as of 00:43, 1 February 2024
Introduction[edit | edit source]
Assessment[edit | edit source]
Red Flags[edit | edit source]
Treatment[edit | edit source]
Manual Therapy[edit | edit source]
Manual therapy techniques can include a number of different hands on approaches. Commonly used manual therapy techniques utilized with patients dealing with lumbar radiculopathy include mobilization of the lumbar spine, mobilization of the nerves, or manipulation. Aspects to keep in mind when deciding to use any hands on technique are contraindications, along with the skill level of the provider and comfort level of the patient. There are patients who's pain symptoms are very irritable to which manual therapy techniques may intensify the pain symptoms.
Mobilization of the Lumbar Spine[edit | edit source]
Spinal mobilizations are passive movement of a spinal segment that follows a grading scale (I-IV). The goal with mobilizations can be to decrease pain symptoms and improve spinal mobility. There is evidence to show that the use of spinal mobilization can be beneficial in the treatment of lumbar radiculopathy. Several studies have found the use of spinal mobilizations with leg movement show some benefit in decreasing pain[1] [2][3][4]. Do keep in mind that in the studies, mobilizations were used in adjunct to other treatments, including exercises and modalities. This can demonstrate that the use of mobilizations should be used as a portion of a possible treatment.
Mobilization of the Nerve[edit | edit source]
Mobilization of the sciatica or femoral nerve is either a tensioning or gliding of the nerve. These are performed similar to the testing procedures of the straight leg raise test, slump test, or femoral nerve test. There is evidence that it can be useful in decreasing pain and improving function[5].
When utilizing these as a treatment, this can be beneficial for patients dealing with acute symptoms to assist in decreasing the sensitivity. They can also be utilized with individuals with a possible entrapment.
Manipulation of the Lumbar spine[edit | edit source]
High velocity, low amplitude (HVLA) or manipulation techniques are often thought of as techniques performed by chiropractors, but also performed by physical therapists and osteopathic physicians. It is a quick, passive movement applied to either a specific level or as a general technique. There is evidence to show that the use of manipulations can be useful with lumbar radiculopathy[6]. Additionally, there is evidence to show that the use of manipulations can decrease the prescription of benzodiazepines[7] and chance of discectomy[8] . The evidence does conclude that the use of manipulation should be used in adjunct with other treatments including exercise.
Exercise[edit | edit source]
Repeated Movements[edit | edit source]
The use of repeated movements is a hallmark of the McKenzie Method or MDT (Mechanical Diagnosis and Therapy). When utilizing repeated movements, the goal is to determine a directional preference, which is the centralization of the symptoms.
Education[edit | edit source]
Modalities[edit | edit source]
Medication[edit | edit source]
Surgery[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ Kuligowski, T., Skrzek, A., & Cieślik, B. (2021). Manual therapy in cervical and lumbar radiculopathy: a systematic review of the literature. International journal of environmental research and public health, 18(11), 6176.
- ↑ Ashraf, B. U. S. H. R. A., Ahmad, S. H. A. K. E. E. L., Ashraf, K. A. S. H. I. F., Kanwal, S. U. M. A. I. R. A., Ashraf, S. H. A. Z. I. A., Khan, N. O. U. M. A. N., ... & SHAFIQUE, S. (2021). Effectiveness of spinal mobilization with leg movement versus McKenzie back extension exercises in lumbar radiculopathy. Pakistan J. Med. Heal. Sci, 15(5), 1436-1440.
- ↑ Danazumi, M., Bello, B., Yakasai, A. & Kaka, B. (2021). Two manual therapy techniques for management of lumbar radiculopathy: a randomized clinical trial. Journal of Osteopathic Medicine, 121(4), 391-400. https://doi.org/10.1515/jom-2020-0261
- ↑ Bello, B., Danazumi, M. S., & Kaka, B. (2019). Comparative Effectiveness of 2 Manual Therapy Techniques in the Management of Lumbar Radiculopathy: A Randomized Clinical Trial. Journal of chiropractic medicine, 18(4), 253–260. https://doi.org/10.1016/j.jcm.2019.10.006
- ↑ Lin L-H, Lin T-Y, Chang K-V, Wu W-T, Özçakar L. Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Life. 2023; 13(12):2255. https://doi.org/10.3390/life13122255
- ↑ Ghasabmahaleh, S. H., Rezasoltani, Z., Dadarkhah, A., Hamidipanah, S., Mofrad, R. K., & Najafi, S. (2021). Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled Trial. The American Journal of Medicine, 134(1), 135-141.
- ↑ Trager RJ, Cupler ZA, DeLano KJ, et al Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA BMJ Open 2022;12:e058769. doi: 10.1136/bmjopen-2021-058769
- ↑ Trager RJ, Daniels CJ, Perez JA, et al Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data BMJ Open 2022;12:e068262. doi: 10.1136/bmjopen-2022-068262
