How can we adapt our adjustments for patients with a disc herniation?

• A. Use standard adjustments as before
• B. Add rotational adjustments
• C. Increase thrust and leverage
• D. Avoid rotational adjustments

Answer: (D)

Rotational forces place torsional stress on the spine that can push disc material toward the nerve roots and raise intradiscal pressure. In a disc herniation, the annulus fibrosus is compromised, so twisting the spine can worsen the herniation and aggravate radicular symptoms. Therefore, adjustments should minimize rotation and use gentle, non-thrust techniques that stabilize and decompress the affected segment. Consider gentle mobilization in a neutral or slightly flexed position, distraction or decompression approaches to reduce disc pressure, and avoid end-range rotations or high-velocity thrusts. By limiting rotational torque, you reduce the risk of further extrusion and nerve irritation, making this the safest modification for herniation.