PROLAPSED INTERVERTEBRAL DISC(PIVD) EXERCISES, CAUSES, SYMPTOMS AND TREATMENT

LUMBAR PROLAPSED INTERVERTEBRAL DISC(PIVD)

• Also, sometimes known as HERNIATED DISC OR SLIPPED DISC

• A prolapsed intervertebral disc is the bulging (protrusion) or ejection (extrusion) of the nucleus pulposus -the gel center-through wear out of the tough circular outer layer intervertebral disc of (annulus fibrosus). 

• It is not a one-time event; rather it is a sequence of changes that take place in the disc, which eventually leads to disc prolapse.

• Protruded or extruded discs may be painless unless they irritate the spinal nerves in the spinal canal

STAGES OR SEQUENCE OF PROLAPSED INTERVERTEBRAL DISC(PIVD)

CAUSES OF LUMBAR PROLAPSED INTERVERTEBRAL DISC (HERNIATED DISC OR SLIPPED DISC)

• Heavy and repetitive weightlifting

• Use of machine tools.

• Operation of motor vehicles.

• Cigarette smokers and tobacco consumers.

• Anxiety and depression.

• Stressful occupation as in doctors, police, etc.

• Women with a greater number of pregnancies.

• Obesity and other cardiovascular risk factors.

• Monotonous work, working overtime, etc.

• Improper postural habits.

• Degenerative changes

• Any trauma which suddenly increases the pressure resulting in rupture of outer covering (annulus fibrosus)

SYMPTOMS OF LUMBAR PROLAPSED INTERVERTEBRAL DISC (HERNIATED DISC OR SLIPPED DISC)

• Repetitive low back pain that radiates to the buttocks and is reduced by rest and Semi-Fowler's position.

• Pain may increase by flexion (forward bending), sitting, straining, sneezing, coughing

• Reduction of sensation or paraesthesia (pins and needles) may occur in some region depending on the level of nerve affected

• Sciatica: Sciatica occurring due to a herniated (nucleus pulposus) gel center usually leads to leg pain that worsens with sitting and improved with standing or lying flat in bed with a pillow under the knees.

• Diffuse tenderness in the lumbosacral region

• Improper posture or Mannequin’s posture

Symptoms to detect high-level disk lesion involving L1 and L2 nerve roots:

• Pain in the groin or testicles.

• Cauda equina lesion.

• Atrophy or weakness of the involved limb.

TREATMENT OF LUMBAR PROLAPSED INTERVERTEBRAL DISC (HERNIATED DISC OR SLIPPED DISC)

• The aim of conservative treatment is to achieve a reduction in symptoms.

• Some cases that do not respond to conservative treatment for 3-6 weeks and the one who presents with cauda equina syndrome may require operative intervention.

• Surgical treatments are: Fenestration, Laminotomy, Hemi-laminectomy, and Laminectomy

• Other treatment includes: CHEMONUCLEOSIS and PERCUTANEOUS DISCECTOMY

CONSERVATIVE TREATMENT FOR LUMBAR PROLAPSED INTERVERTEBRAL DISC (HERNIATED DISC OR SLIPPED DISC)

• Bed rest till the pain reduces but not more than 4-6 days

• NSAIDs to reduce inflammation and pain

• Physiotherapy

PHYSIOTHERAPY FOR LUMBAR PROLAPSED INTERVERTEBRAL DISC (HERNIATED DISC OR SLIPPED DISC)

Modalities

• Heat therapy

• SWD

• Ultrasound

• TENS (Transcutaneous Nerve Stimulation)

• Lumbar Traction

• Exercises

EXERCISES FOR LUMBAR PROLAPSED INTERVERTEBRAL DISC (HERNIATED DISC OR SLIPPED DISC)

LEVEL 1

• ISOMETRIC ADDUCTOR SQUEEZE EXERCISE

• SUPINE PIRIFORMIS STRETCH EXERCISE

• CAT AND CAMEL EXERCISE

• SINGLE-LEG ELONGATION EXERCISE

• SUPINE PELVIC TILT EXERCISE

• BACK EXTENSION EXERCISES

LEVEL 2 (after the pain subsides)

• SIDE GLIDE EXERCISE

• STANDING BACK EXTENSION EXERCISE

• KNEELING SUPERMAN EXERCISE

• BACK EXTENSION EXERCISES (increase the number of repetitions)

When getting on the bed for exercises avoid bending your back, keep your back straight and get on the floor by bending your knees, better to use a couch or bed rather than exercising on a floor when your back hurts.

PRECAUTIONARY GUIDANCE FOR LUMBAR PROLAPSED INTERVERTEBRAL DISC (HERNIATED DISC OR SLIPPED DISC)

• GETTING IN AND OUT OF BED

• TURNING IN BED

• MODIFIED SLEEPING HABITS

AVOID FORWARD BENDING ACTIVITIES AS THAT MAY INCREASE THE DISC TO BULGE OUT MORE.

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