Care Plan 9:   Probable 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: The degree of annular bulging, healing requires a greater amount of time than non-disc injuries because of the avascular (no blood supply) nature of disc tissue. Care is usually of several months duration with initial frequency at 3 or more sessions per week, gradually reducing to PRN frequencies of 1 per month to discharge.

TOTAL: 24-28 sessions over 5 months.

WEEK	CARE	PROGRESS	M	T	W	T	F	S
1	Pain relief (ice) Myofascial work	Gradual relief of muscle spasm and some pain reduction 3-5 /week	X		X		X
2-4	Myofascial work Adjusting/ flexion distraction Home exercise	>50% subjective pain relief >50% improved ROM Decrease in pain distribution 2-3 /week		X		X
5-16	Adjusting Myofascial work Home strengthening exercise	Gradual progressive improvement with resolution PRN follow-ups 1-2 / week			X

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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