Author:

Keywords:

lumbale discus hernia; conservatieve behandeling

Abstract:

Non-operative treatment for lumbar disc herniation and associated radiculopathy – clinical reasoning and rationale for a specific physiotherapy intervention Wim Dankaerts, PhD, PGDip Manip Ther, BSc (Physio), Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Tervuursevest 101, B-3001 Leuven wim.dankaerts@faber.kuleuven.be Intervertebral lumbar disc herniation is a common disorder presenting with low back pain and/or involving nerve root radiculopathy. Despite an abundant literature there is still a controversy concerning the conservative treatment of lumbar disc herniation and associated symptoms (radiculopathies) in the absence of true neurological deficit. These are some of the questions that we attempt to answer during this invited presentation: “Lumbar disc herniation …where is the pain coming from? What is the natural history of lumbar disc herniation and/or radiculopathy? Do herniated disc have the potential for spontaneous regression? Does potential regression coincide with the improvement of associated symptoms? Should (specialized) physiotherapist treat patients with a lumbar IVD lesion and/or associated symptoms? If so, what clinical information is needed? What diagnostic tests should be performed? What imaging studies would be most helpful? How do we clinically evaluate for possible nerve root irritation or compression? What is the effect of loading on the lumbar disc through abnormal or unchanging posture, repetitive activities that stress predominantly flexion? How should we evaluate this clinically? How should be determined whether to continue to treat a patient with a suspected IVD lesion? When should the patient be referred for a surgical opinion? Conclusion It should be clear from this overview of ‘questions & answers’ that, in the absence of progressive neurological deficit (cauda equina syndrome and severe motor deficits) for lumbar disc herniation and/or associated radiculopathy, conservative treatment is the first line of treatment. Extensive clinical examination and reasoning is essential to direct specific intervention addressing the underlying mechanism driving the lumbar pain disorder.