Physiotherapy in Disc Herniation and the McKenzie method

Dynamic examination of the lumbar spine demonstrates postural assessment, the distinction between dysfunction and derangement syndromes, and how flexion, extension, and lateral flexion affect centralization or peripheralization of pain.

Learn to examine deep tendon reflexes of the upper and lower limbs, with precise palpation and hammer technique, comparing sides for hyperreflexia in spasticity and disc-related patterns.

Use the Lasegue test to detect disc herniation and sciatic nerve compression in radiculopathy via passive hip flexion from 35° to 70°. Pain beyond 70° suggests hip, not nerve root.

Apply myofascial release to the lumbosacral and thoracolumbar fascia in prone position, using anterior release coordinated with inhalation and exhalation, then repeat on the opposite side to relax the fascia.

Learn a targeted myofascial release of the iliopsoas and gluteal muscles in a supine position using breathing cues and deep palpation, with guidance on derangement versus dysfunctional disc syndromes.

Apply acupressure and muscle energy techniques to release the quadratus lumborum, gluteal, and piriformis muscles, using prone and supine positions, breathing, and resisted hip internal/external rotation to reduce pain.

Apply McKinsey extension exercises for the lumbar spine to centralize pain, starting from a prone position and advancing to standing extension with neutral pelvis and sacrum stabilization, plus home maintenance.

Learn McKenzie flexion exercises for the lumbar spine, tailored to anterior or posterior herniation and dysfunctional flexion. Use supine, chair, and standing flexion (5–10 reps), ending with extension when indicated.

Learn McKenzie exercises for lateral flexion of the lumbar spine, using pelvic tilt to address derangement and leg pain; begin with extension exercises and progress gradually as pain decreases.

Perform a lumbar postural exercise for derangement syndrome in the bare position with knees down, feet on toes, and a straight lumbar-thoracic line; repeats 5–10 times with breaths.

Showcases a lumbar postural exercise in a flexion direction to tighten the core, especially the transverse abdominals, and stabilize the spine for dysfunctional syndrome.

Stabilize the lumbar spine and centralize pain by applying kinesiotape with horizontal, vertical, and diagonal strips stretched about 80–90%, targeting the derangement syndrome due to disc herniation.

Apply kinesiotape to the lumbar spine for myofascial release in dysfunctional syndrome. Pre-measure and place the tape in a flexed position with 15–20% stretch, securing it for 2–3 days.

Master the dynamic cervical spine examination to differentiate dysfunction from derangement syndromes, using flexion, extension, lateral flexion, and rotation to assess pain, centralization, and nerve compression from disc herniation.

Perform the median nerve aerodynamic test in a supine patient with 90-degree glenohumeral abduction. Slowly extend the forearm to elicit pain and determine maximal nerve mobilization.

Examine the ulnar nerve with neurodynamics by positioning the shoulder, forearm, and elbow to mobilize and extend the nerve; lateral flexion may provoke outer forearm and little finger symptoms.

Assess nervus radialis neurodynamics in supine by guiding arm through index finger flexion, wrist flexion with ulnar tilt, elbow extension, forearm pronation, then abduction to 50 degrees; pain guides treatment.

Apply muscle energy techniques to release the erector spinae, super occipital, and trapezius muscles in supine, using neck elongation and gentle flexion with breath control for cervical disc derangement syndrome.

Apply median nerve neurodynamic mobilization with 90-degree glenohumeral abduction and flexion, forearm at 90 degrees, elbow and wrist extension, guided by breathing to gradually stretch and relax the nerve.

Apply neurodynamic mobilization for the ulnar nerve to alleviate nerve compression from disc herniation, using shoulder abduction, elbow flexion, wrist extension, and external rotation with breathing.

Utilize radial nerve neurodynamic techniques to treat compression, starting with elbow flexion, finger flexion, wrist flexion, and forearm pronation, then progress to forearm extension while guiding breathing.

Practice autotherapy for the median nerve, radial nerve, and ordinary nerve, using wall-based dorsal flexion, elbow extension and shoulder depression, guided by pain levels and breathing cycles.

Perform seated cervical spine traction with occipital and jaw stabilization, using gentle elongation and inhale-exhale breaths. Stop for dizziness or nerve-root pain, then repeat 2–3 breaths per session for improvement.

Teach cervical spine extension and flexion through McKenzie exercises, emphasizing anterior/posterior tilt, centralization of pain, safety from vertigo, and patient self-management with daily repetitions.

Guide the patient through McKenzie thoracic spine extension in a seated position, progressing from mid to upper thoracic levels with ten repetitions to improve extension and prepare for cervical work.

Demonstrates a cervical postural exercise for disc herniation, guiding the patient to keep shoulders away from the ears, elongate the cervical spine, hold for 5–10 seconds, and repeat 5–10 times.

Three cervical kinesiotape applications cover trapezius taping with a Y-cut at the acromion, cervical-spine taping, and lower cervical spine stabilization, all with no stretch.