Home Physiotherapy, Scoliosis & Postural Abnormalities, Synapse Physiotherapy
What Is A Slipped Disc ?
A slipped disc, also known as a disc prolapse, protrusion, or herniated disc, occurs when part of the gel-like disc between the vertebrae leaks out and makes contact with nearby nerves or the spinal cord. It is a common cause of back pain. Patients who experience pain related to a herniated disc often recall a specific event that triggered their discomfort. Following the diagnosis of a slipped disc, it is important to start a physiotherapy program. You can get the best rehabilitation in physiotherapy Malaysia to aid your recovery and help manage your condition effectively.
Causes Of Slipped Discs
Discs are composed of strong connective tissue that functions as shock absorbers for the spine while also allowing movement. Each disc has a tough outer layer that encases a softer, gel-like substance in its center. If the outer layer gets damaged, small tears may form, allowing the inner substance to leak out and contact the nerves or spinal cord. Slipped discs are most common in individuals aged 30 to 50 and tend to affect men more than women. As people age, their discs dehydrate, making them more susceptible to tearing and, consequently, to slipped discs. Additional risk factors include repetitive lifting of heavy objects, prolonged sitting such as during long-distance driving, and being overweight.
Stages , Signs And Symptoms
1. Disc Degeneration:
- Description: The intervertebral discs lose their hydration and elasticity due to aging or repetitive stress, making them less able to absorb shock.
- Symptoms: Often asymptomatic in this stage but may cause mild discomfort or stiffness.
2. Prolapse (Protrusion):
- Description: The outer layer of the disc (annulus fibrosus) weakens, and the inner gel-like core (nucleus pulposus) starts to bulge out but does not rupture the outer layer.
- Symptoms: Mild to moderate pain, stiffness, and possible nerve irritation if the bulge presses against surrounding nerves.
3. Extrusion:
- Description: The nucleus pulposus breaks through the annulus fibrosus but remains within the disc space.
- Symptoms: More pronounced pain, numbness, tingling, and muscle weakness, as the extruded material compresses nearby nerves.
4. Sequestration (Sequestered Disc):
- Description: Fragments of the nucleus pulposus break free from the main disc and migrate into the spinal canal.
- Symptoms: Severe pain, significant neurological symptoms, and possibly loss of bladder or bowel control if nerve roots are severely compressed (cauda equina syndrome).
Diagnostic Method Imaging
- X-rays: X-rays are readily available at most clinics and outpatient offices. This imaging technique can be used to assess structural instability. If x-rays reveal an acute fracture, further investigation with a CT scan or MRI is necessary. X-rays can also show narrowed disc space, loss of lumbar lordosis, and complementary scoliosis.
- CT Scan: A CT scan is preferred for visualizing bony structures in the spine. It can also reveal calcified herniated discs, and the size and shape of the spinal cord, along with the surrounding soft tissue. While less accessible in office settings compared to x-rays, CT scans are more accessible than MRIs. For patients with non-MRI-compatible implanted devices, CT myelography can be used to visualize herniated discs.
- MRI: MRI is the preferred and most sensitive method for visualizing herniated discs. MRI findings assist surgeons and other healthcare providers in planning procedural care when indicated. This imaging technique can identify disc protrusion and nerve root compression.
Physiotherapy assessment
A physiotherapy assessment for a slipped (herniated) disc begins with a detailed patient history, focusing on previous back injuries, surgeries, medical conditions, and the nature and duration of current symptoms such as pain, numbness, tingling, or weakness. The physiotherapist will inquire about the patient’s daily activities, occupation, recent changes in physical activity, and identify movements or positions that aggravate or relieve symptoms. Observation involves evaluating the patient’s posture for abnormalities or asymmetries, observing gait for deviations or limping, and checking for muscle atrophy. Palpation is used to detect tenderness along the spine and surrounding muscles, as well as areas of muscle spasm.
Range of motion (ROM) testing assesses the mobility of the lumbar and cervical spine in various movements, noting any pain or discomfort. A neurological examination is conducted to test deep tendon reflexes, check for sensory deficits, and assess muscle strength in the extremities. Special tests such as the Straight Leg Raise (SLR), Slump Test, and Spurling’s Test help identify nerve root irritation or compression. A functional assessment evaluates the impact of symptoms on daily activities and the patient’s ability to perform functional movements like bending, lifting, sitting, and standing.
If available, imaging studies such as MRI or CT scans are reviewed to confirm the diagnosis and identify the specific location and severity of the disc herniation. Goal setting involves establishing short-term objectives focused on pain relief and inflammation reduction, and long-term goals aimed at restoring normal function, improving strength and flexibility, and preventing recurrence.
Management
- Interventional: Epidural steroid injections, nerve blocks.
- Surgical: Microdiscectomy, laminectomy, or spinal fusion, especially in severe cases or when conservative treatments fail.
- Conservative: Physical therapy, anti-inflammatory medications, pain relievers, lifestyle modifications.
Physiotherapy for a slipped disc
Stretching: Evidence suggests that adding hyperextension to an exercise program may not provide additional benefits compared to intensive exercise alone for functional status or pain outcomes. Similarly, combining strength training with stretching did not show significant differences in disability and pain compared to strength training alone.
Muscle Strengthening: Strong muscles support the spine and can help manage pain. Core stability should be fully regained and controlled before progressing to strength and power training, as improper technique can increase the risk of back problems and pain.
Spinal Manipulative Therapy and Mobilization: These therapies can provide short-term pain relief for acute low back pain. For chronic low back pain, spinal manipulation has shown effects similar to nonsteroidal anti-inflammatory drugs (NSAIDs).
Transcutaneous Electrical Nerve Stimulation (TENS): TENS therapy contributes to pain relief and improves function and mobility of the lumbosacral spine.
Manipulative Treatment: Manipulative treatment for lumbar disc herniation appears safe and effective, potentially better than other therapies, though more high-quality evidence is needed for further investigation.
Traction: Traction therapy has shown positive effects on pain, disability, and straight leg raise (SLR) in patients with intervertebral disc herniation. Combining mechanical traction with medication and electrotherapy may offer additional benefits.
Hot Therapies: Heat therapy increases blood flow to the affected area, delivering oxygen and nutrients that aid healing and removes waste products from muscle spasms.
Cryotherapy: Cold therapy reduces spasm and inflammation, particularly in the acute phase of injury.
Ultrasound: Used as phonophoresis, ultrasound increases the extensibility of connective tissues.
Ergonomic Advice: Provide guidance on proper body mechanics and ergonomic adjustments to reduce strain on the spine.
Frequently Asked Questions (FAQs)
Common symptoms include back pain, numbness, tingling, and muscle weakness. Severe cases can cause loss of bladder or bowel control.
Diagnosis involves a physical examination, patient history, and imaging studies such as X-rays, CT scans, or MRI.
Yes, physiotherapy can help manage pain, improve function, and prevent recurrence through exercises, therapies, and ergonomic advice.
Recovery time varies depending on the severity of the condition and the treatment approach, ranging from a few weeks to several months.
Preventive measures include maintaining a healthy weight, practicing good posture, exercising regularly, and avoiding heavy lifting.
Conclusion
In summary, physiotherapy is essential for rehabilitating both acute and chronic slipped discs, including preventing future issues. Synapse Physiotherapy specializes in creating personalized treatment plans based on thorough assessments. For acute cases, the focus is on reducing pain and inflammation with exercises and therapies. In chronic cases, the emphasis shifts to improving core strength, flexibility, and posture to manage symptoms long-term and prevent recurrence. By teaching proper body mechanics and providing ongoing support, Synapse Physiotherapy helps patients recover effectively and maintain spinal health, ensuring a better quality of life.
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