Prolapse Intervertebral Disc (PIVD) / Herniated disc / Slip disc

Prolapse Intervertebral Disc (PIVD) / Herniated disc / Slip disc

By – Dr. Narendra Kumar Yadav

                BPT, MPT (Neurology)

Prolapsed disc (commonly called a 'slipped disc'), a disc does not actually 'slip'. What happens is that part of the inner softer part of the disc (the nucleus pulposus) bulges out (herniates) through a weakness in the outer part (annulus fibrosus.) of the disc. A PIVD /prolapsed disc is sometimes called a herniated disc

It has four stages-

1.      Bulging

2.      Protrusion

3.      Extrusion

4.      Sequestration

Types of herniation

1.      Central

2.      paramedial

3.      Lateral

What causes a PIVD?

1.      Heavy manual labour

2.      Repetitive lifting and twisting

3.      Postural stress

4.      obesity

5.      Poor and inadequate strength of the trunk

6.      Sitting for long hours

7.      increasing age (a disc is more likely to develop a weakness with increasing age)

Lower Back /Lumbar Herniated Disc Symptoms

1.      Severe low-back pain

2.      Pain radiating to the buttocks, legs, and feet

3.      Pain made worse with coughing, straining or laughing

4.      Muscle spasm

5.      Tingling or numbness in legs or feet

6.      Muscle weakness or atrophy in later stages

7.      Loss of bladder or bowel control in case of cauda equina syndrome

Neck /Cervical Herniated Disc Symptoms

1.      Arm muscle weakness

2.      Deep pain near or over the shoulder blades on the affected side

3.      Increased pain when bending the neck or turning head to the side

4.      Pain made worse with coughing, straining or laughing

5.      Neck pain, especially in the back and sides along with spasm

6.      Burning pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest

7.      Tingling (a "pins-and-needles" sensation) or numbness in one arm

Special Tests for PIVD-

1.      SLR test

2.      Laesegue test

3.      Bowstring test

4.      Femoral stretch test

Physical Therapy Management inPIVD

Before planning the treatment, determine the position of comfort or symptom reduction i.e FUNCTIONAL POSITION. The patient may have...

(a) Extension bias: Patient's symptoms are lessened in position of extension (bending back) and provoked in flexion (bending forwards) e.g PIVD.

(b) Flexion bias: Patient's symptoms are lessened in position of spinal flexion (bending forwards) and provoked in spinal extension (bending backwards) e.g spinal stenosis, spondylolisthesis.

MODALITIES TO REDUCE PAIN AND SPASM-

•  Cryotherapy 
•  TENS
• US
• Moist heat
• SWD
• IFT
• Soft tissue manipulation
• Traction