When the protrusion or extrusion of the nucleus pulposus through a rent in the annulus fibrosus, PIVD occurs. A prolapsed disc is commonly known as ‘slipped disc’, where a disc does not actually slips but the part of the inner softer part of the disc bulges out or herniates through a weakness in the outer part of the disc. The prolapsed intervertebral disc is also known as herniated disc.
It can be divided into four stages. The early stage is known as ‘bulging’. In this early stage, when pressure is relieved, the disc is stretched and it doesn’t completely changes to its normal shape. It gains little bulge at one side of the disc. Some of the inner disc could be torn and the nucleus pulposus (which is a soft jelly) is spiling outwards into the disc fibers only not from the disc.
The second stage can be called as ‘protrusion’. In this stage, the bulge is very eminent and the soft jelly centre has spilled out from the outer fibers to the inner edge, rarely held in by the remaining disc fibers.
The third stage can be known as ‘extrusion’. Here, the soft jelly has completely spilled out of the disc and now protruding out of the disc fibers, when the herniated spinal disc occurs.
In ‘sequestration’, which is the last stage, some of the jelly material is breaking off away from the disc into the surrounding area.
The following are the symptoms can be seen in prolapsed disc:-
- Pain in back and buttock can be felt.
- Weakness or numbness can be felt in one leg or sometimes in both.
- Arm muscle weakness.
- Walking can be painful or difficult.
- From the lower back down one or both legs pain runs.
- In some of the cases loss of bladder or bowel control.
- When you bend over or twist pain gets worse in buttock or back, leg.
- Neck pain, especially in the back and sides with spasm.
- Patience characteristically have tight hamstring muscles which is the muscles in the back of the thigh, decreased flexibility in the lower back and pain or difficulty with arching the back backwards
- Sometimes patience may often complain of sciatic pain.
- Normally, in the sitting position the spinal canal is more open, patience do not have a lot of pain while sitting. the spinal canal gets smaller in the upright position pinching the nerve roots in the canal and accentuating the stenosis.
The causes of prolapsed disc are based on age, heredity and lifestyle:-
- Some children may often suffer from prolapsed disc due to birth defect or injury.
- During adolescence, rapid growth may also be a contributing factor.
- Lifting and twisting again and again can also cause prolapsed disc.
- Sometimes playing sports like football, gymnastics, weightlifting and track and field may also cause your strain to over stretch and put stress on your lower back.
- Increase in weight can also lead to prolapsed disc.
- As the age increases a disc gets more weak.
- Heavy manual labour can also leads to prolapsed disc.
- Sitting for long time can also occur prolapsed disc.
To diagnose prolapsed disc can be prove to be difficult as some people don’t have any symptoms or overwhelming pain. Thus, the following tests are necessary:-
- PHYSICAL DIAGNOSIS:-
- SLR:- The Straight Leg Raise physical examination is a neurodynamic and passive test. With this test range of motion of the neurological tissues as well as the sensitivity is checked.
- Tenderness of the lumbar spine is checked by pressing on it.
- Pain does increases or not while standing and does it relieve while sitting or sleeping.
- Gluteal stretch is painful or not.
- Bowstring test can also be helpful.
- Femoral stretch test.
- IMAGINARY DIAGNOSIS:-
- X-Ray:- An X-ray can be taken by your doctor to diagnose a decrease in the height of space between discs, nerve bundle sclerosis, bone spurs, facet hypertrophy and instability during flexion and extension of limbs.
- CT Scan:– To provide a detailed anatomic picture of your lumbar spine, also of the phone, which will help your doctor to identify abnormalities.
- MRI Scan:- The magnetic resonance imaging which diagnoses using magnetic and radio waves, and creates computer-generated images. It is able to show the cut through multiple layers of the tissues like nerves and ligaments.
- EMG Study:- An electromyogram test looks at the function of the nerve roots leaving the spine. It is done by inserting tiny electrodes into the muscle of lower extremity. On the basis of the electrical signals in the muscles, it show if the muscle is being pinched or irritated as it leaves the spine.
- Excessive Hip Flexion– Due to IT band contractures, Hip flexor spasticity, Hip flexion contractures, hip pain, Compensation for excessive knee flexion and ankle DF, Compensation for excess ankle plantar flexion in mid swing, most commonly the excessive hip flexion can significantly change the gait pattern.
- Hip Abductor Weakness– During the swing phase to allow the opposite leg to lift, the abductor muscles stabilize the pelvis
There are many home treatments which can prevent patients from being operated:-
- Patients can also use hot water bags or ice bags to reduce localized pain. Heat can be applied to relax the muscles and to promote blood flow. Ice can be applied to relive pain.
- Painkillers such as acetaminophen, ibuprofen or oral steroids can be taken to reduce inflammation in the area but with your doctor’s prescription.
The following physiotherapy treatment can be provided by your doctor to treat your prolapsed intervertebral disc pain:-
- Exercise For PIVD( prolapsed intervertebral disc ):-
1). Pelvic tilt
2.) Dead bug exercise
3.) Partial curl
4.) Lateral shift correction
5.)Double knee to chest
6.) The bridge
7.) The plank
8.) Wall squat
9.) Leg lifts
10.) Backward leg swing
11.) Passive extension
- Stretches for PIVD (prolapsed intervertebral disc ):-
1.) Hamstring stretch on wall
2.) Quadriceps stretch
3.) Hip adductor stretch
4.) Isometric hip adduction
5.) Gluteal stretch
ELECTROTHERAPY TREATMENT FOR PROLAPSED INTERVERTEBRAL DISC (PIVD)-
- Ultrasound:- An ultrasound can help to reduce muscle spasms, stiffness, cramping, swelling and pain upto a great extent. It helps by sending sound waves deep inside your tissues creating a gentle heat which increases healing and blood circulation.
- TENS:- A transcutaneous electrical nerve stimulation machine stimulates your muscle with the help of variable intensities of electrical current. It reduces your muscle spasms and increases your body’s production of endorphins, your natural pain killers. ( Electrode placement for PIVD)
- LASER:- Laser therapy treatment is very advance method for pain relief and decrease inflamation,In physiopoint clinic we are using LASER treatment for many painful condition ,and we are getting very good result.It gives an high intensity of light into the tendon. This helps in reduction of inflammation, pain. It also motivates cell reproduction
- Lumbar traction:- Lumbar traction can be a emphatic auxillary for the treatment of a number of common musculoskeletal complaints including facet joint pain, disc degeneration and disc protrusion. If the traction is correctly applied for the patients with lumbar disc protrusion, it may reduce the bulging disc, but the mechanical effect is usually transient. To overcome the inertia of the body, 80 to 200 lb of traction is needed to produce effective distraction of disc. Traction treatment time should be kept relatively short which is 10 minutes for sustained traction and 15 minutes intermittently are probably safe and maximum effective.
- MICRODISCECTOMY:- Microdiscectomy is also known as Microdecompression Spine surgery.
Microdiscectomy usually perform with those patients who suffers from severe radiating pain, numbness in leg which occurs due to spinal decompression of nerve root and herniated disc (bulging, protrusion and extrusion). In this surgery, the orthosurgeon will put inscision in your affected lumbar spine around in 1-2cm of area remove the herniated disc which affects the nerve root compression. After this surgery, no changes are observed in your lumbar structure.The microdiscectomy is a short operation process of 2 hours. Only after the rest for a day after this surgery, patient can continue his/her daily routine activities. In some cases, your surgeon may ask you to take rest for a week.
- LAMINECTOMY:- Laminectomy is a process of removal of lamina, to provide some more space to your spinal canal. Lamina is the back part of vertebra which covers your spinal canal.
This surgery is performed for the patients who have been suffering from spinal decompression of spinal cord. This surgery can be performed only after the failure in conservative, physiotherapy and injections.
Patient are adviced to take rest for 2-3 months after surgery. But patient can perform some of his easy daily activities after a week of the surgery. Your surgeon will also advice you to avoid forward bending, heavy weight lifting and driving
- Manual mobilization for PIVD:Manual mobilization is very effective in the treatment of PIVD ( prolapse intervertebral disc),with the help of some hand manual technique we can adject the lumbar disc alingment ,which help in the decreasing radiate pain and other symptomes