Protruded Lumbar Discs Respond to Manipulation

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                  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:
                        L4-L5 81%
                        L5-S1 16%
                        Multiple levels 2%
                        L3-L4 1%
                        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
                        strongly contraindicated."
                        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
                        manipulation techniques.