Herniated Disk: presentation and management

A patient with a disc herniation with radiculopathy complains of low back pain with associated leg pain, which extends below the knee.  Typically, this is brought on by sudden bending or twisting motions.  These patients are usually no stranger to low back pain, but those cases all resolved. 

Herniated Disc

A herniated disk is compression of a nerve root due to migration of the inner nucleus pulposus beyond its normal barriers.  Researchers now think that the nerve root is not always compressed, but inflamed.  When these nerve roots become compressed, neurological deficits arise and become noticeable to the patient. 

Disc Lesions

The most common location for disc lesions is at the level of L4/L5 and L5/S1.  An L4 nerve root lesion would demonstrate a diminished patellar tendon reflex, numbness on the medial lower leg and foot, and weak foot inversion upon resistance.  An L5 nerve root lesion would demonstrate diminished hamstrings reflex, weakness of big toe dorsiflexion, and numbness on the lateral lower leg.  An S1 nerve root lesion would demonstrate a diminished Achilles reflex, numbness on the posterior lower leg and lateral foot, and weak foot eversion upon resistance.  The straight leg raise (SLR) or well leg raise (WLR) is a strong indicator of a disc lesion when associated leg pain is present. 

Braggard’s Test

Braggard’s test is a confirmation test by quickly dorsiflexing the affected foot.  A disc herniation patient should be managed with chiropractic care, but rotation should be avoided completely.  A supine adjustment with the patients knees flexed is the best position or flexion/distraction technique should be administered.  This technique decreases compression and pumps the disc offering the patient pain relief and increased range of motion.  Activator technique and SOT have also been found useful in treating a herniated disk.