CERVICAL DISC HERNIATION Long-term cervical spine pain, radiating to arm/hand/fingers can be caused by degenerative changes in the cervical vertebrae in terms of bone spurs or bulging discs/herniated disc. This is a common condition that increases in frequency with age among both men and women, partially as a result of normal aging. Trauma to the cervical spine, including whiplash, appears to increase the risk of developing pain several years later. When suffering from cervical disc herniation, the pain and impaired nerve function aswell as the tingling/ numbness (paraesthesia) can cause very severe inconveniences in terms of function of the arm and hand. Usually these are treated with conservative (non-surgical) measures, but if the symptoms are severe and persist for a long period of time, surgery may be required. The pain and impaired function can seriously affect the quality of life. (91) GUIDELINES START OF TREATMENT
As soon as possible after symptoms occur TYPE OF LASER
Infrared and/or red light, for example: 904 nm, sp, 60 mW 780-860 nm, p/k, 300 mW/450mW 650-660 nm, k, 35 mW Note that a high power output requires a higher dose to ensure the treatment time to be long enough. If the pain is acute treat with doses within high dose range. DOSAGE
904 nm: minimum 2-4J (30-65 seconds) per treating point (cm2). 780-860 nm: minimum 4-16J (300 mW 15-55 seconds, 450 mW 10-35 seconds) per treating point (cm2). 650-660 nm: minimum 1-3J (30-90 seconds)
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Laser Therapy – a practical guide
per treating point (cm2). Please note that the treatment point, when using class 4 lasers in distance from the skin surface, is the whole area treated. The dose per point is the total dose used treating the specific area. To calculate dose per cm2, divide the total with the cm2 treated. METHOD AND AREA OF TREATMENT
Start treatment with infrared light, as a suggestion with 904 nm in skin contact with pressure (if possible) over facet joints in the segment where the disc herniation is located, aswell as a couple of segments above and below. If necessary, continue treatment over m trapezius, m levator scapulae, suboccipital muscles, m sternocleidomastoideus, mm scalenii and interscapular muscles. If level of pain is not reduced after conducting a re-test, increase the dose at painful area by treating once more with the same laser or using another wavelength (for example 808 nm). This is important especially in the area where the disc herniation is located but also at painful trigger points over facet joints and in m trapezius, suboccipital muscles and inter/ intrascapular areas. For treatment of deep located nerves (deeper than 2 cm) use infrared light. Treat over the nerves located at the level of pectoralis minor and in arm, for example the area of the elbow and forearm. Use doses within high dose range. For treatment of more superficial nerves (within 1-2 cm from the skin) use red light, as a suggestion 650 nm, over affected cervical segments and their nerves. Also treat other areas where the nerve is superficial, as in the gap between m scalenus anterius and medius. In addition at the level of elbow and fingers when pain and nerve disorders are experienced. Use higher doses where the nerve is located deeper and
lower doses where the nerve is very superficial. TREATMENT INTERVAL
A minimum of 2-3 treatments during the first week is recommended. If possible the client can be treated every day for 3-4 consecutive days and after that 2-3 treatments a week. When the symptoms start to decrease in terms of intensity, the intervals are recommended to be phased out accordingly. TREATMENT RESULTS
Results should be clearly measurable from 3-5 treatments. Improvements are however frequently noted also after 1-2 treatments. EVALUATION
vas or vrs 0-10 during rest and functional movement tests aswell as palpation. COMBINED TREATMENT
> mdt (McKenzie) – repetitive movements
or static positions > Circulation and weight training > Posture correction > Heat or cold > Ergonomic coaching > tens. > Massage IMPORTANT
Make sure to inform about possible reactions to the treatment before starting session. Mainly it is important to inform about resistance restrictions if the client experiences strongly reduced pain since there are some movements that can intensify the disc herniation (especially rotations). REFERENCES
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Laser Therapy – a practical guide
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GUIDELINES: CERVICAL DISC HERNIATION
Primary treatment area: Infrared light, 808–830 nm, 904 nm Primary treatment area: Infrared/red light, 808-830 nm, 904 nm, 650-660 nm