Q&A Time! Spinal Loading/Unloading vs Disc/Movement

This week's Q&A Time comes from a clinician who is taking one of my MedBridge Courses.

"One of our students asked a question about The Eclectic Approach to Clinical Neurodynamics: Part A.

Some confusion with your terminology. You equate flexed postures with "unloading," and more erect postures with loading. I thought it was the other way around. Even the famous Alf Nachemson studies on disc pressures showed increased Hg (on discs, which I equate with increased loading on the spine) with flexed postures, esp. slumped sitting or leaning forwards seated into flexed posture. My pts. with active disc issues(so I think) don't sit but stand or sit on edge of Rx table deloading themselves with UE Hg relief postures. Please explain what you mean?"


That is a great question. Since I have evolved from explaining pathoanatomy to patient's, I avoid using words like "disc" etc, instead preferring only to explain directional preference in terms of movement. When I say "unloading" in my head I am referring to the gapping of facets, and loading refers to WB or being able to tolerate load on bilateral or ipsilateral facets. It does not have anything to do with intradiscal pressures. It has been proven that repeated motions many times DO NOT reduce disc buldges probably more times than they do, yet they still help.

So I evolved my style of teaching and educating patients to tell them they need to be able to restore load, or WB. Even in your example, patients think they need to unload, but in reality, it is not resetting their nervous system or restoring function, it's just a band aid. Repeated motions in the directional preference, which is often a novel position or movement strategy is what they need to modulate their systems and reduce perceived threat, not what they are doing over and over again with no change. Does this make sense?

Want to see my courses on MedBridge? If you need to brush up on some modern/Eclectic ways to treat TMD and a fresh taken on Neurodynamics, we have you covered! Save $225 on their normal $400 a year subscription by subscribing through my link here!

Keeping it Eclectic...