Q&A Time! Spinal Loading/Unloading vs Disc/Movement | Modern Manual Therapy Blog

Q&A Time! Spinal Loading/Unloading vs Disc/Movement



This week's Q&A Time comes from a clinician who is taking one of my MedBridge Courses.

"One of our students asked a question about The Eclectic Approach to Clinical Neurodynamics: Part A.

Some confusion with your terminology. You equate flexed postures with "unloading," and more erect postures with loading. I thought it was the other way around. Even the famous Alf Nachemson studies on disc pressures showed increased Hg (on discs, which I equate with increased loading on the spine) with flexed postures, esp. slumped sitting or leaning forwards seated into flexed posture. My pts. with active disc issues(so I think) don't sit but stand or sit on edge of Rx table deloading themselves with UE Hg relief postures. Please explain what you mean?"


That is a great question. Since I have evolved from explaining pathoanatomy to patient's, I avoid using words like "disc" etc, instead preferring only to explain directional preference in terms of movement. When I say "unloading" in my head I am referring to the gapping of facets, and loading refers to WB or being able to tolerate load on bilateral or ipsilateral facets. It does not have anything to do with intradiscal pressures. It has been proven that repeated motions many times DO NOT reduce disc buldges probably more times than they do, yet they still help.

So I evolved my style of teaching and educating patients to tell them they need to be able to restore load, or WB. Even in your example, patients think they need to unload, but in reality, it is not resetting their nervous system or restoring function, it's just a band aid. Repeated motions in the directional preference, which is often a novel position or movement strategy is what they need to modulate their systems and reduce perceived threat, not what they are doing over and over again with no change. Does this make sense?



Want to see my courses on MedBridge? If you need to brush up on some modern/Eclectic ways to treat TMD and a fresh taken on Neurodynamics, we have you covered! Save $225 on their normal $400 a year subscription by subscribing through my link here!

Keeping it Eclectic...

2 comments:

  1. Agree with you 100% about rapid changes as neurophysiological rather than reducing disc herniation. Can you suggest some articles that describe this or debunk disc theory.

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  2. I think even MDT references articles that show repeated loading may not reduce a disc (especially in the cervical spine as it's very unlikely discs are pain generating as opposed to lumbar where it may be relevant in some cases). The references basically said the repeated loading still centralized Sx but no changes were seen on MRI. I would have to look for them. I mostly reference Joel Bialowsky's work on what modern manual therapy (or any exercise claimed to change issues in the tissues).

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/

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