A therapist evaluating a patient with an acute lumbar disc protrusion and a right lateral shift of the thoracic spine. Which finding would be the BEST indicator that the symptoms will respond positively to the PT intervention?

A therapist evaluating a patient with an acute lumbar disc protrusion and a right lateral shift of the thoracic spine. Which finding would be the BEST indicator that the symptoms will respond positively to the PT intervention?

• A. The pain is referred only to the buttock and not the thigh
• B. The patient prefers standing and walking than sitting
• C. There is a decrease in lumbar lordosis
• D. Repeated backward bending centralizes the pain

Answer: (D)

Centralization with repeated extension is the strongest indicator that mechanical therapy will help a lumbar radiculopathy. When repeated backward bending (extension) makes the leg pain move closer to the spine or diminish, it shows the nerve root is responding to the movement and that the disc material is shifting away from the nerve. This directional preference suggests a favorable prognosis with extension-based PT approaches, such as repeated extension exercises, prone press-ups, or similar movements, because they tend to centralize symptoms and reduce radicular irritation. The other signs are less predictive of a positive PT response. Pain referral limited to the buttock without thigh involvement doesn’t demonstrate the same reversible nerve root irritation. A preference for standing and walking over sitting reflects comfort in a position but doesn’t indicate a therapeutic direction or likely improvement with PT. A decrease in lumbar lordosis is a postural finding that doesn’t reliably predict responsiveness to PT. Therefore, the ability of repeated backward bending to centralize symptoms best signals that PT interventions are likely to be effective.

Centralization with repeated extension is the strongest indicator that mechanical therapy will help a lumbar radiculopathy. When repeated backward bending (extension) makes the leg pain move closer to the spine or diminish, it shows the nerve root is responding to the movement and that the disc material is shifting away from the nerve. This directional preference suggests a favorable prognosis with extension-based PT approaches, such as repeated extension exercises, prone press-ups, or similar movements, because they tend to centralize symptoms and reduce radicular irritation.

The other signs are less predictive of a positive PT response. Pain referral limited to the buttock without thigh involvement doesn’t demonstrate the same reversible nerve root irritation. A preference for standing and walking over sitting reflects comfort in a position but doesn’t indicate a therapeutic direction or likely improvement with PT. A decrease in lumbar lordosis is a postural finding that doesn’t reliably predict responsiveness to PT. Therefore, the ability of repeated backward bending to centralize symptoms best signals that PT interventions are likely to be effective.