Care Plan 10:   Probable Discogenic Involvement
With Soft Neurologic Signs

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

ETIOLOGY: In addition to pain from inflammatory products and reflex spasm, a bulging disc may insult structures in and around the nerve roots or the root itself. In the presence of soft neurologic signs such as paresthesia (numbness or tingling), hyper- or hypoesthesia (increased/ decreased sense of touch), and pain radiation along a radicular distribution, a variety of chiropractic approaches are appropriate for a clinical trial.

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. This condition is treated in similar fashion to disc conditions without radicular findings: however, neurologic involvement may contribute to additional spasm and may slow response to care. 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: 26-30 sessions over 5-6 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

PRN = per required need (patient request)

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.

Return to DISCOGENIC CONDITIONS