Why do some disc problems not respond to McKenzie movements and fail to centralize?

  • Some disc problems involve a tear in the annulus (soft cartilage of the disc) that is the cause of the pain rather than the disc bulging.

This annular tear can leak inflammatory exudate (inflammatory chemicals), which can chemically irritate the nerve and give leg symptoms such as aching, burning, tingling and numbness.

McKenzie movements do not apply, as there is no disc bulge to “squash back”, with the nerve being chemically irritated rather than mechanically squashed by the disc.

These problems are also termed internal disc disruption or IDD by some practitioners.

  • Other disc problems involve an extrusion (piece of disc material that is no longer moveable with McKenzie movements) or a sequestration) a piece of disc material that has actually separated and is seen on MRI as a separate fragment.

Whether the fragment has separated or not these disc problems involve displaced nuclear material within the disc that cannot be influenced with repeated movements due to the extent of the damage.

Will this problem improve if it can’t be rapidly improved with McKenzie movements?

  • Disc problems that fail to rapidly respond to the McKenzie Assessment procedures WILL GET BETTER in the vast majority of patients.
  • The big difference is instead of a rapid improvement that is seen with patients that DO demonstrate a direction preference with McKenzie testing; the timeframe for recovery is much longer.
  • 95% of irreducible disc problems with improve with time and natural recovery within 6 months -18 months. Some patients fortunately recover faster and some can take up to 24 months.

What role do surgery, injections and medication play in these disc problems?

  • Medication, usually anti-inflammatory (eg. Voltaren, Ibuprofen or stronger steroids like Prednisolone) or neuropathic drugs (eg. Lyrica, Neurontin) aim to reduce the pain caused by the compression on the disc and the inflammatory cells released from the annular tear.
  • Medications are used predominantly to settle acute flare-ups or to settle severe symptoms to enable you to cope while this natural healing is slowly taking place.
  • Injections can be made around the nerve (epidural) or into the nerve root (nerve sheath injection) to relieve leg symptoms in some individuals who are not coping and not responding to other medication.
  • Surgery is usually a last resort, especially since the vast majority of these severe problems do improve naturally within the 6-month to 2-year time frame discussed earlier. Surgery can be indicated and successful in certain patient presentations, especially for those who are in a lot of pain and not coping well due to the severity of their problem.

Microdiscectomy warrants its own discussion as although it is spine surgery that sounds frightening to most patients, it has an 80-90% success rate for patients with leg pain as the predominant symptom. The surgery is minimally invasive compared to other spine surgery options like fusion, and can be a good option for many patients.