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By - Aishwarya Pore

This document discusses pivd (prolapsed intervertebral disc) and its physiotherapy management. It covers the 4 stages of pivd, common causes like repetitive stress and obesity, clinical features like back pain and numbness, assessment tests, and treatment approaches including McKenzie exercises, modalities like ultrasound and TENS, traction, core strengthening, and addressing muscle imbalances like in lower and upper cross syndromes.

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Nelson Lobo
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121 views38 pages

By - Aishwarya Pore

This document discusses pivd (prolapsed intervertebral disc) and its physiotherapy management. It covers the 4 stages of pivd, common causes like repetitive stress and obesity, clinical features like back pain and numbness, assessment tests, and treatment approaches including McKenzie exercises, modalities like ultrasound and TENS, traction, core strengthening, and addressing muscle imbalances like in lower and upper cross syndromes.

Uploaded by

Nelson Lobo
Copyright
© © All Rights Reserved
Available Formats
Download as ODP, PDF, TXT or read online on Scribd
Download as odp, pdf, or txt
Download as odp, pdf, or txt
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PIVD

By - Aishwarya Pore
Introduction
• Stages of pivd-
It has 4 stages-
1. Bulging – the disc is stretched and doesn’t return to its normal shape
when pressure is relieved. It retains a slight bulge at one side of the
disc.
2. Protrusion – the bulge becomes more prominent and nucleus pulposus
spills upto inner edge of outer fibres.
3. Extrusion – herniation of disc, the nucleus pulposus is completely
spilled out.
4. Sequestration – the nucleus pulposus spreads into the surrounding area.
5.
Etiology
• Repetitive mechanical stress.
• Sedentary lifestyle
• Trauma to spine
• Obesity
• Poor posture etc
•
Clinical features
• Severe low back pain
• Radiating pain
• Neurological claudication
• Pain worsens with coughing, laughing, sneezing
• Muscle spasm
• Tingling or numbness in extremities
• Altered posture
• Reduce strength in extremities
•
Assessment
• History – any strenuous activity in past few days which aggrevated
back ache.
• Posture – curvature of spine, pelvic tilt scoliosis
• Movement – ranges of lumbar and cervical spine
modified Schober’s test for lumbar ranges
• Tenderness and spasm – palpate paraspinal muscles.
•
Cross syndromes-
Opposite and diagnol muscles go into tightness and other pair goes
into weakness
• Upper cross syndrome
Weak muscles- cervical flexors
rhomboids and lower trapezius
Tight muscles – upper trapezius and levator scapulae
pectoralis
• Lower cross syndrome
weak ms. - abdominals
gluteus maximus
tight ms. – thoracolumbar extensors
hip flexors
• Special test
for cervical spine
1. Foramina compression test / spurling test
2. Distraction test
3. ULTT

1.
• https://youtu.be/rir6x6Iiqc4
For lumbar spine
1. Slr
2. Lasegues’s test
3. Bowstring test
•
Slump test and modification
• Slr/ lasgues testand modifications
• Prone knee bending test
•
Investigations
• MRI
Physiotherapy management
• Determine the functional position – position of comfort or reduced
symptoms Mekenzie exercises to centralize pain
1. Extension bias- reduced symptoms in extension of spine
1. Flexion bias – reduced symptoms on flexion
Spinal extension is contraindicated if –
• When no position or movement decreases or centralizes the pain
• When urinary incontinence
• When patient holds the body immobile due to extreme pain
•
• Modalities to reduce pain –
Tens – sweep mode
Waveform – trapezoid Duration- 10min

Ultrasound - phonophoresis for pain relief and accelerates healing


Intensity – acute 0.5 W/cm2 Chronic 0.8 W/cm2
Duration – 5-8 min
Moist heat – for spasm
IFT – 4 pole vector for radiating pain
Frequency Base 100- sweep 50hz

Traction – relieves pressure over the disc


• Traction
Manual traction
Core strengthening
Isometric exercises
Upper cross syndrome
Strengthening the cervical flexors and scapula retractors
Stretching cervical extensors, scapula elevators and pectorals
Lower cross syndrome
Strengthening the abdominals and glutes
Stretching back extensors and hip flexors
•
Thank you

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