Mechanical physiotherapeutic diagnosis and therapy in patients with lumbardisc disease

In a time frame of 30 months, 21 patients with radiographically confirmed l umbar disc prolapse and prominent referred leg pain (n = 21) and neurologic al deficits (n = 16) were managed nonsurgically using medication and physio therapy in a prospective, single-arm phase II trial. The 21 patients were s elected for nonsurgical therapy from a group of 69 patients based on specif ic changes in pain perception during mechanical assessment. The strategy of physiotherapy involved repetitive active and passive movements of the vert ebral column. Therapeutic movements were selected according to the change o f symptoms induced by these movements. The mechanical assessment was repeat ed in each therapy session to reassess symptom-relieving movements. Respons e to therapy was monitored by the shortest achieved distance from fingers t o ground upon bending forward, signs of nerve and root tension, pain, senso ry loss, muscular strength, intake of analgesics, subjective feeling of wel l-being, and the patient's ability to work. After a median in-patient treat ment of 12 days, all 21 patients were discharged in clinically improved con dition. At the first follow-up assessment after a median of 42 days, the co ndition of 19 of 20 patients had further improved compared with the end of the in-patient treatment. At the second followup assessment after an averag e period of 262 days, 16 of 18 patients still felt better than at the time of hospital discharge and the time of the first follow-up visit. This study shows that physiotherapy, according to the concepts of McKenzie and Maitla nd, is an effective therapy for lumbar disc prolapses, and indicates that a reliable prediction of response to conservative treatment can be obtained from the mechanical assessment and the changes of symptoms during five phys iotherapy sessions.