This topic contains 9 replies, has 7 voices, and was last updated by 
William Brady, DC April 10, 2020 at 2:38 pm.
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William Brady, DC
Hi Everyone,
I hope you are all staying healthy. Since we have some time on our hands I am considering having a webinar. The topic would be exploring the case study with Johnny (visit 14 was just posted). Post here if you are interested AND post a question or comment about a specific visit. If I get enough questions or comments I will schedule the webinar. Sound good?
Thanks
Adam Holen D.C.
From visit 14, how/why would a cluneal nerve entrapment create morning stiffness? If I’m following, this is the potential next layer in his case where you may do a few visits. Would you not be more interested in the L4 disc bulge as the remaining cause of symptoms? How does the nerve entrapment play into what’s left vs the L4 disc? So far he’s doing single leg hip lifts, lunges, but only 10LBS on good morning’s. Is there any logic with increasing that weight? Or adding a core exercise to bolster strength around the spine?
These have been great to watch and really helped shore up some mistakes I’ve been making. Thank you for posting.
James Phipps
Disc resorption is a topic I would like to know more about. I can see how treating QLF and load management would help with disc resorption but does treating sciatic nerve at the external rotators help with that as well? (Will that extra nerve tension on the disc prevent resorption?).
During your communication with him regarding disc resorption you said that he was out of the woods as far as the nerve being squished and compressed but isn’t that area much more likely to herniate out again? (or is that a discussion for another day, and that visit was all about the victory?)
I would have already added 15 pounds to the good morning, what information made you hold off on that for now and add upper body exercises instead?
BJJ is a topic that hasn’t really come up with him since the initial visit. Do you anticipate having to discuss this with him? Your communication has set it up so he hasn’t even asked about it, which highlights how good communication will prevent questions like that.
Overall this case showed me how good communication can get, how fast adhesion can break down even with a massive disc herniation, and how not to be in a rush to add load.
Thank you for taking the time to record and post it, this has been a tremendous help to my practice.
Seth Schultz, DC
I’ll echo JJ with the disc resorption topic. Will any level of disc protrusion be resorbed when following ID load/capacity principles or only ones that haven’t started to migrate?
Carl Nottoli, DC
I third a disc resorption topic. What does the literature say and how can we have better prognostic control with our ID skills?
Brian Zelasko, DC
I agree with all the above. Is there any way to reasonably predict if a disc bulge/herniation has the potential to resorb? Like Carl mentioned, I imagine myself with a similar patient on Day 1, looking at this MRI, knowing his ID testing results, is there anything else you look for to be able to confidently say this disc has a chance to resorb or not.
Brandon Cohen DC, CSCS
I consistently struggle with knowing how much of a change we can make with irreducible blocks. The disc resorption concept would be interesting to explore.
My utilization of exercise has also changed since watching the case study. I was slower to implement and faster to progress patients.
William Brady, DC
Thanks for the replies. I just made a video answering your questions. Should have it posted tomorrow.
Adam Holen D.C.
As I rewatch this series waiting for any response on SBA/PPP loans, is there any utility to measuring his thoracic flexion? Maybe like T6 down. I know his case was pretty straight forward after the history/exam, but you did have a webinar a while back about the importance of thoracic flexion and how we likely don’t use it as often as we should.
For this case specifically with his new/primary symptom of superior cluneal nerve entrapment, would the ESA/TDF have any play in that from lower T/S dysfunction? Where do you draw the line on if it’s worth testing and when?
In general, for a low back patient, are there any specifics that you use for determining when it’s worth opening that can of worms (T/S flexion)? Sclerotome/dermatome from higher L/S segments? Really bad QLF? Symptoms when attempting good morning or inability to keep the spine neutral?
I know you’ve already recorded the video so these are more curiosity questions about adding value to a case vs. missing something that could limit MMI.
William Brady, DC
Video is posted: https://integrativediagnosis.com/case-study-forum-questions/
To Adam’s questions: Thoracic flexion a much bigger deal with shoulder and cervical spine issues. I would only test it if there were some provocative position or motion that suggested it would be relevant. Here we did not have a provocative suggestion for thoracic involvement. Yes, your list of reasons to test thoracic range makes perfect sense.
Thanks for the comments and questions.
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