Protruded Lumbar Discs Respond to Manipulation
Thursday, March 26, 2009
Protruded Lumbar Discs Respond Well to Manipulation
Written by Dan Murphy, D.C., D.A.B.C.O.
TAC, Research Review , Volume 31, Issue 3
KEY POINTS FROM DR. DAN MURPHY
1. Low back pain accounts for one-third of all
orthopedic outpatient visits, and is often related to
problems with the intervertebral disc.
2. Manipulation has been used in Chinese healthcare for
thousands of years. By the Tang Dynasty (618-907 AD),
"manipulation was fully established and became a routine
for the treatment of low back pain."
3. "In the Western world, Hippocrates was considered to
be the earliest pioneer to have documented
4. In this study of 517 patients with protruded lumbar
discs, 84% responded well to manipulation, and 9% did
not respond to manipulation.
5. These authors conclude, "manipulation of the spine
can be effective treatment for lumbar disc protrusions."
"Most lumbar disc protrusions could be effectively
treated by manipulation."
6. In the photographic depiction in the article, there
is clearly a side-posture rotary manipulation of the
lumbar spine, described as follows: "The patient is
placed on the sound side first with the hip and knee of
the painful side flexed and the sound side straight. The
operator rests one hand in front of the shoulder and the
other hand on the buttock. By simultaneously pulling the
shoulder backwards and pushing the buttock forwards, a
snap or click can usually be heard or felt. Then
manipulate in the opposite direction and a similar snap
or click may be heard or felt. This manipulation may
then be repeated on the other side as required."
7. These authors state that rotation "is the key
maneuver of the manipulation…. Manipulation usually
begins with preparatory movements of the vertebral
joints to their extreme and then rotation is carried
8. "Gaping of the disc on bending and rotation may
create a condition favorable for the possible reentry of
the protruded disc into the intervertebral cavity, or
the rotary manipulation may cause the protruded disc to
shift away from pressing on the nerve root."
9. "During manipulation a snap may accompany rotation.
Subjectively it has dramatic influence on both patient
and operator and is thought to be a sign of relief."
10. "If derangement of the facets or subluxation of the
posterior elements near the protruded disc occurs, the
rotation may have caused reduction, giving remarkable
11. The incidence of protruded discs was:
Multiple levels 2%
12. "Most protruded discs may be manipulated. When the
diagnosis is in doubt, gentle force should be used at
first as a trial in order to gain the confidence of the
13. "Manipulation may also be used as one component of
the combined treatment for ‘facet syndrome’ and for
associated lesions of extradural origin, such as
ligamentous or muscular lesions."
14. "For a central protrusion or a huge disc with
incontinence or paraplegia, manipulation is of course
15. "The manipulation will only be beneficial just prior
to the critical point. The amplitude of force applied
cannot be measured and can only be estimated by
experience. Therefore, expertise plays an important role
in the success of manipulation."
16. Practice is necessary to become proficient in spinal