Care Plan 8:   Possible Discogenic Involvement
Without Neurologic Signs

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

ETIOLOGY: Disc protrusion may produce pain from inflammatory products at the disc itself. It may also produce reflex spasm and resultant pain. This condition usually arises from lifting and loading while rotating at the waist.

APPROPRIATE CARE: Myofascial soft tissue work, flexion distraction and adjusting, along with a home regimen of exercises will reduce spasm and increase ROM.

EXPECTED FREQUENCY AND DURATION OF CARE: During the first 2-4 weeks of care the differential diagnosis between disc and non-disc involvement can be made. The initial care plan follows the probable disc protocol, with the remainder of care dependent on the determination of disc involvement. Those that appear to be disc related will continue the probable disc protocol. Non-disc diagnosis will conclude care along the protocol of that non-disc care plan that is appropriate.

TOTAL: Up to 10 sessions during the first month. Then care follows the care plan for the appropriate diagnosis.

WEEK	CARE	PROGRESS	M	T	W	T	F	S
1	Pain relief (ice) Myofascial work	Gradual relief of muscle spasm and some pain reduction 3 /week	X		X		X
2-4	Myofascial work Adjusting/ flexion distraction Home exercise	>50% subjective pain relief >50% improved ROM 2-3 /week		X		X
>4	Depends upon final diagnosis	As expected according to the final diagnosis

ATTENUATING FACTORS: The nature of the symptoms, the degree of the initial disc injury, general metabolic health and compliance with home exercise plan all contribute to recovery time.

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