Intervertebral Disc Prolapse
IVDP is a hydrostatic, load bearing structure between the vertebral bodies from C2-C3 to L4-S2.
IV disc consist of 3 distinct component.
1. The Cartilage end plate: Here the cartilage end plate cover the disc both from both the side above and below.
2. Annulus fibrous: water + proteoglycans + Collagen type I
3. Nucleus pulposus: water + proteoglycans + Type II collagen
Function Of IVDP
• Restricted IV joint motion
• Contribution to stability
• Resistance to axial rotation and bending load
• Preservation of anatomic relationship
Intervertebral disc prolapse
• Also known as spinal disc herniation.
• Intervertebral Disc Prolapseis a condition which is affecting the spine in which there will be a tear in outer fibrous ring ( Annulus Fibrous) of the Intervertebral Disc Prolapse causes the soft central portion ( nucleus pulposus) to buldge out & causes pressure on the spinal cord and its accompanying nerve roots.
Types of herniation
1.posterlateral disc herniation – Occurs in L5
2. Central disc herniation – Occurs in L2, Cauda equina
3. Lateral disc Herniation – Occurs in L4 root
It occur in 3 stages
2. Nucleus displacement
3.stage of fibrosis
Degeneration changes occur in disc before the displacement of nuclear material.
Softening of nucleus and its fragmentation.
1. Protrusion : Nuclues tends to buldge within Annulus fibrous.
2.prolapse : Tear in the Annulus fibrosis begin
3.Extrusion : Tear has opened up & the nucleus pulposus cone out of annulus fibrous
4.Sequestrum : Fragment comes out compity with tear of annulus fibrous
3.stage of fibrous
Here, calcification of buldged part occur along with osteophytes 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
• Serve low back pain
• Radiating pain occur to the buttocks legs & feet
• Walking can be painful or difficult
• Pain get worse with coughing, straining, or laughing activity
• Muscle spasm
• Muscle weakness
• Tingling or numbness in leg or feet
• Loose of bladder kr bowel control
Inspection : Look for postrual abnormalities ( scoliosis, lordosis, kyphosis)
Tenderness: At the level of posterior articulation of the involved segment and pain on percussion of affected IV space.
To test flexion- Patient standing position ask the patient to bend forwards
Lateral flexion- Patient should be in standing poistion and ask the patient to bend to the left or right.
Extension- Ask the patient to bend backward
Rotation- Patient standing position 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- In standing position ask the patient to lift the leg in prone.
Position- Pain is present in anterior aspect of thigh indictates high level disc lesion.
Special test :
• Slump test
• Passive lumbar extension test
• Laregue’s test
• Bowstring test
• Prone knee bending test
• Spurling test
• Distraction test
• Compression test
• Shoulder abduction test
1.X-ray: Narrowed disc space- Loss of lumbar lordosis
2. Ct scan – Bulging of disc
3.MRI- Intervertebral disc protrusion, compression of nerve root
-Extra dural tumor
• Cauda equina syndrome
• Chronic pain
• Permanent injury
• Conservative treatment
• Pain medication- NSAID’S muscle relaxant
• Best rest
• Oral sterioid
• Nerve root block
• Surgery treatment is recommended when conservative treatment get failed.
• Hemi laminectomy
• Percutaneous disecting
1.Cryotherapy for acute
It is indicated during acute low back pain as it reduces pain, swelling and muscles spasm
It delays the nerve conduction
Heat can causes vasodilation due to this there will be reduce the muscle ischemia.
It decreases the pain and relive the muscle spasm
a. Superficial heat
3. Tens: Given in both chronic and acute condition
4. Traction: It stretches the spinal muscle and ligament and thereby reduce the intra disasular pressure.
It distract the vertebral body and facet joint.
5. corset and braces
They increases intra abdominal pressure the force is diverted against the diaphragm and thoracic spine.
Some amount of load will be transmitted to the oblique & transverse abdominal muscles.
6. Spinal manipulation
Mannual force is use to bring abduction the passive movement either within or beyond the active range of motion.
Massage help by stimulating the tissue and thus relaxes the contracted muscles.
• Forward bending
• Increased lumbar lordosis
• Fixed lumbar lordosis with bending lordosis
• Knee hugs
• Pelvic tilt
• Repeated back bend
• Decreased lumbar lordosis
• Prone as elbow
• Extension control
• Hamstring stretch
• Reduces pain
• To strengthen the muscle
• To stretch contracted muscle, ligament, capsule
• To improve mobility
• To improve posture
Physiotherapy after surgery
Mobilization should be done as early as possible
Normal lumbar lordosis to be maintained
-Upper limb movemet
-Gluteal and quadriceps isometric
-Hip and knee flexion by heel drag
2. In 2nd and 3rd post operative days
-Turning the whole body as one unit from supine and side lying positions.
3. After week
-Isometric abdominal exercise
-Assisted spinal extension position
4. After 4 week
-Graded spinal extension exercises
-Graded spinal flexion, rotation, and side flexion exercises
-Ambulation with correct posture and gait.