Introduction
All test procedures are performed in such a way that they cause the least possible stress for the patient. Due to the high irritability (= irritability, small stimulus = large effect) of the event, caution is already required during the examination. Examination of active and passive spinal mobility in flexion, extension, rotation and lateral inclination.
The therapist will have certain test movements performed to ensure the most accurate findings and re-findings possible. Specific passive examination for malposition of the lumbar vertebrae and testing the extent of movement between the individual spinal segments. Caution is required when performing the lumbar vertebrae Schmezprovokation test.
If the pain is so severe that the patient cannot bear the pressure or the pain makes it impossible to distinguish the affected vertebral segments, the test must be stopped. Strength test of the abdominal muscles and back muscles and identification muscles of the legs for the affected spinal segment (weakness in certain leg muscles – foot lifter, foot reducer, toe flexor and toe extensor – allows conclusions to be drawn about the affected spinal segment), if feasible Coughing, sneezing, pressing causes pain The areas of skin associated with the spinal segment are examined for their sensitivity (sensation of touch, pressure and temperature). The reflexes associated with the affected spinal segment (e.g. hamstring reflex or Achilles tendon reflex) are examined.
Neuromechanical examination: The peripheral nerves in the knee and foot region are scanned to assess their irritability. When lifting the stretched leg from a supine position on the affected side, an increased resistance to movement against lifting the leg is observed and the known nerve pain caused by the stretching of the sciatic nerve occurs. The further away from the trunk the pain occurs, the more likely the cause of the pain is directly caused by the intervertebral disc.
in an upright sitting position, the affected leg is stretched out and the foot is pulled up towards the body; in addition, the cervical spine is bent. The stretching of the sciatic nerve and the spinal meninges reproduces the patient’s typical pain. from the supine position, with the hip and knee joint bent, a direct compression (pressure) is applied to a branch of the sciatic nerve, thus triggering the known pain.
If an MRI finding already exists in which a certain segment can be held responsible for the pain, the results of the manual test procedures should correspond to the MRI findings. After the physiotherapeutic findings have been determined and the patient has been informed about the problem and the prognosis, the individual treatment plan is drawn up and trial treatments are carried out. In the following treatment suggestions, I assume that the complaints can be clearly assigned to the diagnosis: lumbar disc herniation and are not caused by other structural changes in the spine or by a functional disorder in the sacroiliac joint and/or the lumbar spine. Here you can go directly to the treatment plan for a herniated disc