Management of slip disc with physiotherapy

The human body has got 33 vertebrae and between two vertebra there is a disc which acts as a shock absorber in human beings. The intervertebral disc has three distinct components, the cartilage end plates, nucleus pulposus and annulus fibrosus. The nucleus pulposus is the central portion of the disc which is consists of a gelatinous material and that lies posterior to the central axis of vertebrae. The nucleus pulposus is enclosed by the annulus fibrosus which is the outer covering of the disc.

The intervertebral disc acts as a shock absorber and prevents rubbing of two spines. The disc also helps in increasing the height of a human being.

The slip disc or the prolapsed intervertebral disc has four stages-

1. Stage of degeneration- since spines have less blood flow hence the intervertebral disc also has got less blood flow which leads to lack of nutrition in the disc and lack of water and this leads to over a period of time degeneration of the intervertebral disc. The nucleus of the disc becomes soft and fragmented. Though the disc is broken and fragmented but it doesn’t come out of the spine.
2. Stage of protrusion or disc bulge- the nucleus pulposus of the intervertebral disc is under pressure all the time. When the outer covering the annulus fibrosus becomes weak either because of injury or any other cause, this leads to bulging of the nucleus through the the defect. This is called disc protrusion.
3. Stage of extrusion- since the nucleus of the disc is fragmented and the annulus fibrosus is also broken, the disc pushes through the annulus fibrosus its outer covering and comes out of the spine but it is still supported by the longitudinal ligament. Even in this position the disc has not lost all its contact with the parent dis hence it is called disc extrusion.
4. Stage of sequestration- once the disc is extruded, it will not go back. The posterior longitudinal ligament is also not strong enough to hold the disc from bulging out further. The extruded disc loses all its contact with the parent disc and this is called sequestrated disc.

Symptoms- the broken and sequestrated disc may lie in the spinal canal which leads to the compression of the nerve root causing severe pain in the lower back region and it also causes radiating pain in the lower limb. The posture of the patient may also become little forward bent and he may not be able to walk properly. In certain cases there is severe tenderness, redness and swelling in the lower back region. At times there is numbness and paraesthesia in leg and foot. There might also be weakness of certain muscle groups of the lower limb.

Physiotherapy treatment includes-

1. Rest- rest is most important in the treatment of prolapsed disc. The physiotherapist advises the patient to sleep on a hard mattress for 2 to 3 weeks.
2. Hot and cold packs- application of hot and cold pack leads to increase in blood flow that leads to a reduction in pain as the blood contains natural analgesics and healers. The increase in blood flow also leads to relaxing of muscles.
3. Lumbar traction is also given to the patient to ease out the pressure at the nerve roots.
4. Transcutaneous electrical nerve stimulation is given to the patient in the radiating area of the pain to ease out the pain and to regenerate the compressed nerve.
5. Ultrasonic therapy is also given to the patient to reduce the pain and increase blood flow which leads to healing and muscle relaxation.
6. When the pain has reduced to a great extent, strengthening of core muscles starts which leads to further support of the prolapsed disc. Stretching of lower limb muscles also gives a lot of relief.