Indicators for Disc Herniation Supported by Magnetic Resonance Imaging (MRI)

Remeta EM Poster Presentation 9th Annual Clinical Meeting of the American Academy of Pain Management, Las Vegas, NVSep 1998

The SOTO (Step Out Turn Out) maneuver is utilized in Sacro Occipital Technique (SOT) both diagnostically and therapeutically in the treatment of disc herniations. This study evaluated a five case review from patient records where positive SOTO maneuver findings were correlated to MRI results. The SOTO maneuver is performed on patients with lower extremity radiating pain. The patient is prone and the affected leg is then abducted, the leg externally rotated and foot dorsiflexed. This position is held for 30 seconds and then placed in the neutral position for one minute and then repeated. The patient’s report of the change in pain intensity (same, better or worse) determines the indicated findings.

The SOTO maneuver is purported to help differentiates between lumbar disc lesions from a piriformis muscle syndrome. Additionally the SOTO maneuver is also used to assist diagnosis into the type and severity of the disc lesion.

Positive SOTO maneuver findings for piriformis muscle syndrome is determined by elimination of the radiating pain after the first time the maneuver is performed. Disc findings, on the other hand, were associated with reports of no change or worsening of the patient’s symptomatology, after the first maneuver. For these patients the maneuver was performed two additional times at one-minute intervals. Findings of “same, same, better” or “same, better, better” offered a good prognosis following SOT Category Three chiropractic conservative care.

Findings of increased pain on second and third attempts of the maneuver was indicative of disc fragmentation and high probability necessitating surgical intervention. A clinical study was performed to test the diagnostic accuracy of the SOTO maneuver in patients with lumbar disc lesions. The study was accomplished by comparing initial examination SOTO indicators and results of MRI. A high degree of accuracy was observed in being able to differentiate a disc bulge versus disc herniation via the SOTO Maneuver, as supported by MRI. Therefore the five cases studied, where positive disc finding were indicated by the SOTO maneuver followed by MRI, offered consistent findings for segregating disc fragmentation from disc protrusion and prolapse.

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