IV disc conisit of 3 distinct component
1. The cartilage end plate: Cover the disc both above and below.
2. Annulus fibrosis: Water +proteoglycans + collagen type I
3. Nucleus pulposus: Water more + proteoglyans +type II collagen.
Function of IVD
Restricted IV joint motion
Construction to stability
Resistance to axail rotation and bending load
Preservation of anatomic relationships
Intervertebral disc prolapse
-Also know as spinal disc herniation
-IVDP is a condition affecting the spine in which a tear in outer fibrous ring ( Annulus fibrous) of the IVD cause the soft central portion (Nucleus pulposus) to buldge out and causes pressure on the spinal cord and its accompanying nerve roots.
Types of herniation
Posterlateral disc herniation- Its occur in Lumbar 5
Costral (Posterior) disc herniation- it occur in lumbar 2 and cauda equina
Lateral disc herniation- its occur in lumabr 4 nerve root
It occur in 3 stages
3. Stage of fibrosis
Degeneration changes occur in disc before the displacement of nuclear materal.
Softening of nucleus and its fragmentation.
2. Nucleus displacement
1.protrusion: Nucleus tends to buldge within annulus fibrosis.
2.Extrusion: Tear in the annulus fibrosis begin.
3. Extrusion: Tear has opened up and the nucleus pulposus come out of annulus fibrosis.
4.Sequestrum: Fragment come out compity with tear of annulus fibrosis.
3.stage of fibrosis
Here, calcification of buldged part occurs along with osteophyte formation.
• Repetitive mechanical activity
• Traumatic injury to lumbar disc
• Living a sedentary life style
• Practising poor posture
• Tobacco abuse
• Lumbar: L4- L5 or L5-S1
• Cervical: C5- C6 or C6-C7
• Severe low back pain
• Pain radiating to the buttocks, legs and feets
• Walking can be painful or difficult
• Pain made worse with straining, laughing or coughing
• Muscle spasm
• Muscle weakness
• Tingling or numbness in leg or feet
• Lose of bladder or bowel control
Inspections: Look for postural abnormalities (Scolosis, lordosis, kyphosis)
- Tenderness: At the level of posterior articulation of the involved segment and pain on percusion of affected IV space.
- To test flexion: Ask the patient to bend forwards
- Lateral flexion: Ask the patient to bend to the left or right
- Extension: Ask the patient to bend backwards
- Rotation: Ask the patient to rotate from the waist to left and right.
- SLR test: Ask the patient to raise the leg at 90° Without flexing the knee.
- Femoral nerve test: Ask the patient to lift the leg in prone.
- Position: Presence of pain in anterior aspect of thigh indicates high level disc lesion.
-Patient is ask to raise the leg in supine position.
-0-30° – Hamstring tightness
-30-45° – Sciatica, peripheral nerve injury
-45-70° – SI joint or hip involvement
2. Slump test
-In sitting position, ask the patient to bend forward with neck flexion and instructed to raise the leg.
3.Passive lumbar extensions test
-Ask the patient to extend the trunk
4. Lasegue’s test
6. Prone knee bending test
• Spurling test
• Distraction test
• Compression test ULTT
• Shoulder abduction test
-Narrowed disc space
-Loss of lumbar lordosis
-Bulging of disc
-Intervertebral disc protrusion, compression of nerve root
• Ankylosing spondylitis
• Vascular insufficiency
• Extra dural tumour
• Spinal tuberculosis
• Cauda equina syndrome
• Chronic pain
• Permanent injury
• Pain medication:
• Muscle relaxant
• Bed rest
• Oral steroids
• Nerve root block
If conservative treatment fail we can go for surgery
• Hemi- Laminectomy
• Percutaneous disectomy
1. Cryotherapy (For acute)
-It is indicated during acute low back pain as it reduces pain, swelling and muscle spasm.
-It delays the nerve conduction
-Heat causes vasodilation there by reducing the muscle ischemia.
-It decrease the pain and relieves the muscle spasm.
A. Superficial heat
Given in both chronic and acute condition
4. Traction: It stretches the spinal muscles and ligament and thereby reduce the intra disclar pressure. It distract the vertebral body and facet joint.
5. Corset and braces
They increase intea abdominal pressure the force is diverted against the diaphragm and thoracic spine.
Some load will be transmitted to the oblique & transverse abdominal muscles.
6. Spinal manipulation
Mannual force is use to bring about the passive movement either within or beyond the active range of motion.
Massage helps by stimulating the tissue and thus relaxes the contracted muscles.
• Forward bending
• Increased lumbar lordosis
• Fixed lumbar lordosis witb bending
• Knee hugs
• Pelvic tilt
• Repeated back bend
• Decreased lumbar lordosis prone on elbow
• Extension control
• Hamstring stretch
• Reduce pain
• To strengthen the muscle
• To stretch contracted muscles, ligaments and capsule
• To improve mobility
• To improve postures
Physiotherapy after surgery
-Mobilization should be done as early as possible
-Normal lumbo lordosis to be maintained
-Upper limb movement
-Gluteal and quadriceps isometric
-Hip and knee flexion by level drug
2. In 2nd -3rs post operative drug
Turning the whole body as one pattern from supine & side lying position.
3. After week
-Isometric abdominal exercise
-Assisted spinal extension position
4. After 4 week
-Graded spinal extension exercise
-Graded spinal flexion, rotation and slide flexion exercise
-Ambulation with correct posture and gait.