07/10/2025
Some common conditions we’ve seen in the clinic lately and how we treat them…
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DISC HERNIATIONS
🔷 What it is: often results from a mechanical overload or repetitive loading of the spine over a short time frame, resulting in a breach of the outer wall of the disc (annulus fibrosus), by the central disc material (nucleus pulposus).
🔷 Stages: the stages of disc injury include an annular tear, a disc bulge, disc protrusion, disc extrusion, and finally a disc sequestration.
🔷 Treatment options: pharmaceutical interventions to reduce pain, particularly if there is involvement of a nerve root. Dry needling to reduce paraspinal muscle spasm. Joint mobilisation to assist in desensitising mechanical pain. MET and stretching techniques to encourage safe movement through a pain barrier. Motor control exercises to reengage trunk and lumbopelvic musculature that has been impacted by the activity of pain neurons. Identify and promote directionally preferred movements (often extension, but not always). Traction therapy to decompress pain sensitive structures.
HEADACHES
🔷 What it is: migraines, tension headaches, cervicogenic headaches.
🔷 Treatment options: soft tissue manipulation to the neck, upper back, and facial muscles (including dry needling). Joint mobilisation to the upper cervical spine (such as prone lying PA mobilisations) and mobilisations with movement (MWM) for end range neck pain. Joint manipulation (HVLA) when indicated. MET to improve range of motion (particularly lateral flexion). Prescription of a neck and thoracic stretching program, as well as isometric neck exercises. Pharmaceutical interventions often utilised for migraine symptoms.
TENDINOPATHIES
🔷 What it is: common when there is a sudden increase in the overall load a tendon can accommodate.
🔷 Treatment options: Load management (sport-specific). Exercise regression often beginning with isometric exercises, then eccentric strengthening exercises, before building back up to heavy concentric exercises, plyometric work and higher velocity exposure. PRP, shockwave therapy, straps and braces depending on the type of tendinopathy.
