It appears from a study by Vucetic and Svensson1 that only three physical signs are of real diagnostic value in predicting whether there is a lumbar disc herniation and the degree or grade of herniation. This study was a prospective rather than a retrospective study on 163 consecutive patients operated on for probable herniated discs. The three signs were the range of lumbar sagittal motion, the Lasegue sign, and the crossed Lasegue sign. They found that these tests were significant for the presence of a herniation and the degree of herniation, but not accurate for the level of herniation.
Neurologic signs, while important for distinguishing between radicular and referred pain, are not of great value in diagnosing the grade or level of a herniation.2 One third of patients with an absent Achilles reflex had a hernia above L5-Sl and the diagnostic value of an absent Achilles reflex may decrease with age.3 The absence of an Achilles reflex is more reliable than a diminished reflex as a sign of disc herniation, and its diagnostic value increases markedly if correlated with diagnostic imaging.4 Although patellar areflexia is six to seven times more common in L3-L4 hernias than other levels, only one-quarter of the patients with this sign had L3-L4 hernias.1
The strongest indicator for the grade of hernia was the range of sagittal lumbar motion. The range of lumbar motion decreased with increasing grades of herniation. The range was negligible for protruded hernia (generalized bulge with root involvement), and progressively decreased with an extruded disc hernia (posterior ligament still intact) and sequestrated (complete hernia beyond the posterior ligament). The crossed Lasegue sign, which was meaningful only if it was associated with the unilateral positive Laseque sign, was also proportionate to the grade of the hernia. Therefore the use of both the lumbar range-of-motion and crossed Lasegue sign predicted 74 percent of uncontained (sequestrated hernias), and 68 percent of contained hernias (protruded and extruded). In this study the Lasegue was only considered positive if pain radiated to the foot.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
