13/08/2025
๐๐ง๐ค๐ก๐๐ฅ๐จ๐๐ ๐๐ฃ๐ฉ๐๐ง๐ซ๐๐ง๐ฉ๐๐๐ง๐๐ก ๐ฟ๐๐จ๐ (PIVD)
Also known as Herniated Disc, Slipped Disc, or Disc Prolapse
๐ง ๐ผ๐ฃ๐๐ฉ๐ค๐ข๐ฎ of the Intervertebral Disc
โขThe spine is made up of vertebrae stacked on top of one another, with intervertebral discs situated between them. These discs act as shock absorbers and allow flexibility in the spine.
โขEach disc has two major components:
1. Nucleus Pulposus
-Gelatinous central portion
-Composed of water, collagen, and proteoglycans
-Responsible for absorbing vertical loads
2. Annulus Fibrosus
-Outer fibrous ring made of concentric lamellae
-Composed of Type I and Type II collagen
-Provides tensile strength and keeps the nucleus in place
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๐ฅ ๐๐๐๐ฉ ๐๐๐ฅ๐ฅ๐๐ฃ๐จ ๐๐ฃ ๐๐๐๐ฟ?
When the annulus fibrosus weakens or tears, the nucleus pulposus may protrude or leak out. This displacement can compress or irritate nearby spinal nerves, leading to a variety of symptoms.
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๐ ๐๐ฅ๐๐๐๐ข๐๐ค๐ก๐ค๐๐ฎ
-Peak incidence: Ages 30โ50
-Gender: Slightly more common in males
-Most affected region: Lumbar > Cervical > Thoracic
-Most common levels:
I) Lumbar: L4-L5, L5-S1
II) Cervical: C5-C6, C6-C7
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๐ฏ ๐๐ฉ๐๐ค๐ก๐ค๐๐ฎ (Causes)
๐น Mechanical/Physical Factors:
-Improper lifting techniques
-Repetitive bending, twisting, or vibration
-Sudden trauma or fall
๐น Degenerative Factors:
-Disc dehydration and loss of elasticity with age
-Microtears in annulus over time
๐น Lifestyle Factors:
-Prolonged sitting
-Smoking (dehydrates the disc)
-Obesity
-Sedentary lifestyle
๐น Genetic Predisposition:
-Family history of early disc degeneration
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๐ฌ ๐๐๐ฉ๐๐ค๐ฅ๐๐ฎ๐จ๐๐ค๐ก๐ค๐๐ฎ
PIVD progresses through four stages:
1. Disc Degeneration
-Loss of water content โ decreased disc height
-Weakening of annulus
2. Prolapse (Bulging Disc)
-Nucleus starts to displace but is still contained
3. Extrusion
-Nucleus breaks through the annulus, remains connected
4. Sequestration
-Fragment of nucleus breaks off and migrates
This progression often leads to mechanical compression and chemical irritation of nerve roots, triggering an inflammatory response.
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โ ๏ธ ๐พ๐ก๐๐จ๐จ๐๐๐๐๐๐ฉ๐๐ค๐ฃ of Herniation (By Position)
1) Central โ Can compress spinal cord or cauda equina
2) Paracentral โ Most common; compresses traversing nerve root
3) Foraminal โ Compresses exiting nerve root
4) Far lateral โ Rare; can cause severe nerve root compression
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๐ข ๐พ๐ก๐๐ฃ๐๐๐๐ก ๐๐๐๐ฉ๐ช๐ง๐๐จ
1. Pain
โขLocalized: Back or neck
โขRadiating:
-Lumbar: Sciatica โ pain radiates down buttock, thigh, leg
-Cervical: Brachialgia โ pain radiates into arm and hand
2. Sensory Symptoms
โขNumbness, tingling, pins & needles
โขDermatomal distribution
3. Motor Deficits
โขMuscle weakness
โขReduced grip strength or foot drop (depending on level)
โขReduced deep tendon reflexes
4. Functional Impairments
โขDifficulty walking, prolonged standing
โขReduced trunk or neck mobility
5. Red Flag Symptoms (Cauda Equina Syndrome)
โขSaddle anesthesia
โขUrinary retention or incontinence
โขBowel dysfunction
โขBilateral leg weakness
โ Surgical Emergency
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๐งช ๐ฟ๐๐๐๐ฃ๐ค๐จ๐ฉ๐๐ ๐ผ๐ฅ๐ฅ๐ง๐ค๐๐๐
๐ฉบ Clinical Examination
1) History: Mechanism of onset, location of pain, aggravating/relieving factors
2) Physical Tests:
-Straight Leg Raise (SLR) โ Reproduces sciatic pain
-Cross SLR โ More specific for nerve root compression
-Slump Test
-Spurlingโs Test โ For cervical radiculopathy
-Neurological exam โ Power, sensation, reflexes
๐ผ๏ธ Imaging
1) MRI (Gold Standard) โ Shows disc morphology, nerve root involvement
2) CT Scan โ Useful if MRI is contraindicated
3) X-rays โ Show alignment, degenerative changes (not soft tissues)
4) EMG/NCV โ Used if neuro symptoms persist without imaging findings
---by dr Muhammad Bilal pt
๐งฐ ๐๐๐ฃ๐๐๐๐ข๐๐ฃ๐ฉ
๐ข Conservative Treatment (First-line for most cases)
๐ Medical
1) NSAIDs: Reduce inflammation (e.g., Diclofenac, Ibuprofen)
2) Muscle relaxants: Relieve spasms
3) Neuropathic agents: Gabapentin, Pregabalin
4) Short course of corticosteroids: Oral or epidural (e.g., Methylprednisolone)
๐ ๐๐๐ฎ๐จ๐๐ค๐ฉ๐๐๐ง๐๐ฅ๐ฎ
โ
Acute Phase (0โ2 weeks)
-Relative rest (1โ2 days max)
-Modalities: TENS, IFT, cryotherapy
-Gentle ROM & positioning exercises
-McKenzie extension exercises (for lumbar PIVD)
-Education on avoiding flexion, lifting
โ
Subacute Phase (2โ6 weeks)
-Core stabilization: Transverse abdominis, multifidus
-Pelvic tilts, bridging
-Flexibility of hamstrings, piriformis
-Postural correction exercises
-Gentle traction (manual or mechanical)
โ
Chronic Phase (>6 weeks)
-Progressive resistance training
-Functional rehabilitation
-Cardiovascular conditioning (walking, swimming)
-Ergonomics & body mechanics retraining
-Return-to-activity or work planning
๐ ๐๐๐๐๐จ๐ฉ๐ฎ๐ก๐ ๐ผ๐๐ซ๐๐๐
-Weight management
-Quit smoking
-Ergonomic workplace setup
-Avoid prolonged sitting or forward
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๐ ๐๐ง๐ค๐๐ฃ๐ค๐จ๐๐จ
- Excellent in most cases with conservative treatment
- 80โ90% of patients improve in 6โ12 weeks
- Re-injury possible without lifestyle correction or rehab
- Long-term recovery depends on rehab compliance and prevention strategies
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๐ ๐๐ง๐๐ซ๐๐ฃ๐ฉ๐๐ค๐ฃ
-Maintain healthy body weight
-Regular core strengthening exercises
-Use lumbar support while sitting
-Avoid lifting with spine flexed
-Educate patients on spine hygiene and ergonomics
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โ
๐พ๐ค๐ฃ๐๐ก๐ช๐จ๐๐ค๐ฃ
Pr*****ed Intervertebral Disc is a highly treatable condition if diagnosed early and managed appropriately. Physiotherapists play a crucial role in not only pain relief and restoration of function, but also in educating the patient for long-term prevention. A multidisciplinary approach ensures optimal recovery and minimizes recurrence.
