disc herniation and drop foot

[rosekh]

Hi every one this is my first post and I really enjoyed your discussion all , I have a case of stenosis that causes my patient right lower limb weakness but main problem is drop foot she have about 2+ muscle power in dorsiflexion and eversion I gave her electrical stimulation for 20 repetion only ,and active exercises for the weak muscles , also heel rasise and toe raise , stretching calf-muscles ,gait-training i wana know if there is anything else i can add so i can accelerate the muscle power gaining?

[CenteredHealth]

Hello,
It sounds like you are putting together a good functional program, and adding E-Stim is always a good idea for muscle recruitment. However, you are missing the reason the foot drop is there in the first place; the disc herniation. We as physiotherapists need to address the root causes of functional impairments to fully help our patients.

I have seen foot drop disappear after one treatment with the following techniques.

The disc herniation needs to be addressed. This can be done by adjusting the lumbar, sacral and pelvic biomechanics with simple muscle energy techniques. Remember that intradiscal pressure increases greatly when the spine is flexed, rotated and sidebent; so is the case when one particular vertebrae is stuck in this way. So, lets take the L5S1 disc for example. Typically, L5 will shear anterior over the sacrum or be stuck in flexion, either way this will bias the L5 disc posterior, irritating the S1 nerve root. We must also remember laws of spinal mechanics, which state that the lumbar spine has both Type I and Type II mechanics. Type I mechanics occur when the spine rotates and side bends to opposite sides, as in a scoliotic pattern (typically 3 or more segments). Type II mechanics occur when the spine rotates and side bends to the same side (can be one or multi segmental). So imagine L5 stuck in a Type II dysfunction where L5 is now flexed, rotated and side bent to either the right or left (FRSL or FRSR); this will greatly increase intradiscal pressure and bias the L5 disc posterior and either right or left, irritating the S1 nerve root. The same goes for the remainder of the spine. Address L4 mechanics for improved L5 nerve function, address L3 mechanics for improved L4 and L5 and possibly S1 nerve function. (The above is assuming a posterior lateral herniation) Also requiring adjusting is the sacrum, as a mal-positioned sacrum will cause the remainder of the spine to compensate and contribute to faulty mechanics, disc herniations, nerve root irritation, protective muscle spams, etc.

By addressing the faulty mechanics of the lumbosacral junction you can greatly reduce the disc herniation (if not eliminate it all together) and thereby reduce the irritation of the nerve root causing the foot drop.

[linbin]

hi centerhealth
your post is thought provoking.you are trying to explain the various misalignment/dysfunction that may happen.i would like to highlight the fact that no studies has shown the ability of clinical therapists to detect accurately spinal levels.so you can speak stories but when comes to practise its really difficult to accurately localise the dysfunction .

[CenteredHealth]

Originally Posted by linbin

hi centerhealth
your post is thought provoking.you are trying to explain the various misalignment/dysfunction that may happen.i would like to highlight the fact that no studies has shown the ability of clinical therapists to detect accurately spinal levels.so you can speak stories but when comes to practise its really difficult to accurately localise the dysfunction .

Thanks for the reply Linbin. My evidence based practice is relied more upon the results of my treatments rather than what others have tried to prove or disprove with research papers. Typically the reason why the research is so poor when it comes to the manual therapies is due to the fact that when researchers try to replicate the manual treatments, they rely on clinicians with limited experience which needless to say drastically affects the end result. This phenomenon is seen when looking at all the conflicting research studies dealing with CranioSacral Therapy.

Any clinician with enough skill and experience can accurately detect and treat specific dysfunctional spinal levels. And when treating specific dysfunctions, you begin to fire a sniper rifle at the problem instead of a shotgun. The results are undeniable and at times life changing. I should have some of my patients post replies here.

A simple way to detect specific spinal lesions and to create a hierarchy of dysfunctions is through an Osteopathic treatment approach called Mechanical Link. Anyone interested in correctly and accurately diagnosing specific lesions in the body I recommend doing some reading in this area. There is also some work done by Sharon Weiselfish, which she has named Myofascial Mapping. Again, another technique in which you zero in on specific dysfunctions.

Thanks for the input Linbin, I look forward to hearing a reply.

[rosekh]

Hi again thank you colleagues for your comments and really I enjoyed the informations you have posted its refreshing , and my patient now discharged from the hospital with muscle power 4... +4 for foot muscles and independent walking but next time I will consider your notes for more patient benefit
thanks alot ... rosekh

[linbin]

hi
thanks for the reply.i would like to know about mechanical link and myofascial mapping which you described.if you have any articles related to it please put up here.so it will be helpful to all
cheers

[CenteredHealth]

Originally Posted by linbin

hi
thanks for the reply.i would like to know about mechanical link and myofascial mapping which you described.if you have any articles related to it please put up here.so it will be helpful to all
cheers

Mechanical Link was created by a French Osteopath named Paul Chuffer.
Myofascial Mapping was created by an American Physical Therapist named Sharon Weiselfish.

Both have books and courses on the subjects as well as research materials. Enjoy.