13/08/2025
𝙋𝙧𝙤𝙡𝙖𝙥𝙨𝙚𝙙 𝙄𝙣𝙩𝙚𝙧𝙫𝙚𝙧𝙩𝙚𝙗𝙧𝙖𝙡 𝘿𝙞𝙨𝙘 (PIVD)
Also known as Herniated Disc, Slipped Disc, or Disc Prolapse
🧠 𝘼𝙣𝙖𝙩𝙤𝙢𝙮 of the Intervertebral Disc
•The 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.
•Each 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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💥 𝙒𝙝𝙖𝙩 𝙃𝙖𝙥𝙥𝙚𝙣𝙨 𝙞𝙣 𝙋𝙄𝙑𝘿?
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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📊 𝙀𝙥𝙞𝙙𝙚𝙢𝙞𝙤𝙡𝙤𝙜𝙮
-Peak incidence: Ages 30–50
-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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🎯 𝙀𝙩𝙞𝙤𝙡𝙤𝙜𝙮 (Causes)
🔹 Mechanical/Physical Factors:
-Improper lifting techniques
-Repetitive bending, twisting, or vibration
-Sudden trauma or fall
🔹 Degenerative Factors:
-Disc dehydration and loss of elasticity with age
-Microtears in annulus over time
🔹 Lifestyle Factors:
-Prolonged sitting
-Smoking (dehydrates the disc)
-Obesity
-Sedentary lifestyle
🔹 Genetic Predisposition:
-Family history of early disc degeneration
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🔬 𝙋𝙖𝙩𝙝𝙤𝙥𝙝𝙮𝙨𝙞𝙤𝙡𝙤𝙜𝙮
PIVD progresses through four stages:
1. Disc Degeneration
-Loss of water content → 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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⚠️ 𝘾𝙡𝙖𝙨𝙨𝙞𝙛𝙞𝙘𝙖𝙩𝙞𝙤𝙣 of Herniation (By Position)
1) Central – Can compress spinal cord or cauda equina
2) Paracentral – Most common; compresses traversing nerve root
3) Foraminal – Compresses exiting nerve root
4) Far lateral – Rare; can cause severe nerve root compression
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💢 𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙁𝙚𝙖𝙩𝙪𝙧𝙚𝙨
1. Pain
•Localized: Back or neck
•Radiating:
-Lumbar: Sciatica – pain radiates down buttock, thigh, leg
-Cervical: Brachialgia – pain radiates into arm and hand
2. Sensory Symptoms
•Numbness, tingling, pins & needles
•Dermatomal distribution
3. Motor Deficits
•Muscle weakness
•Reduced grip strength or foot drop (depending on level)
•Reduced deep tendon reflexes
4. Functional Impairments
•Difficulty walking, prolonged standing
•Reduced trunk or neck mobility
5. Red Flag Symptoms (Cauda Equina Syndrome)
•Saddle anesthesia
•Urinary retention or incontinence
•Bowel dysfunction
•Bilateral leg weakness
→ Surgical Emergency
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🧪 𝘿𝙞𝙖𝙜𝙣𝙤𝙨𝙩𝙞𝙘 𝘼𝙥𝙥𝙧𝙤𝙖𝙘𝙝
🩺 Clinical Examination
1) History: Mechanism of onset, location of pain, aggravating/relieving factors
2) Physical Tests:
-Straight Leg Raise (SLR) – Reproduces sciatic pain
-Cross SLR – More specific for nerve root compression
-Slump Test
-Spurling’s Test – For cervical radiculopathy
-Neurological exam – Power, sensation, reflexes
🖼️ Imaging
1) MRI (Gold Standard) – Shows disc morphology, nerve root involvement
2) CT Scan – Useful if MRI is contraindicated
3) X-rays – Show alignment, degenerative changes (not soft tissues)
4) EMG/NCV – Used if neuro symptoms persist without imaging findings
---by dr Muhammad Bilal pt
🧰 𝙈𝙖𝙣𝙖𝙜𝙚𝙢𝙚𝙣𝙩
🟢 Conservative Treatment (First-line for most cases)
📌 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)
📌 𝙋𝙝𝙮𝙨𝙞𝙤𝙩𝙝𝙚𝙧𝙖𝙥𝙮
✅ Acute Phase (0–2 weeks)
-Relative rest (1–2 days max)
-Modalities: TENS, IFT, cryotherapy
-Gentle ROM & positioning exercises
-McKenzie extension exercises (for lumbar PIVD)
-Education on avoiding flexion, lifting
✅ Subacute Phase (2–6 weeks)
-Core stabilization: Transverse abdominis, multifidus
-Pelvic tilts, bridging
-Flexibility of hamstrings, piriformis
-Postural correction exercises
-Gentle traction (manual or mechanical)
✅ Chronic Phase (>6 weeks)
-Progressive resistance training
-Functional rehabilitation
-Cardiovascular conditioning (walking, swimming)
-Ergonomics & body mechanics retraining
-Return-to-activity or work planning
📌 𝙇𝙞𝙛𝙚𝙨𝙩𝙮𝙡𝙚 𝘼𝙙𝙫𝙞𝙘𝙚
-Weight management
-Quit smoking
-Ergonomic workplace setup
-Avoid prolonged sitting or forward
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📈 𝙋𝙧𝙤𝙜𝙣𝙤𝙨𝙞𝙨
- Excellent in most cases with conservative treatment
- 80–90% of patients improve in 6–12 weeks
- Re-injury possible without lifestyle correction or rehab
- Long-term recovery depends on rehab compliance and prevention strategies
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🔄 𝙋𝙧𝙚𝙫𝙚𝙣𝙩𝙞𝙤𝙣
-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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✅ 𝘾𝙤𝙣𝙘𝙡𝙪𝙨𝙞𝙤𝙣
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.
