IVDP
A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patient’s who experience pain related to a herniated disc often remember an inciting event that caused their pain. Unlike mechanical back pain, herniated disc pain is often burning or stinging, and may radiate into the lower extremity. Furthermore, in more severe cases, there can be associated with weakness or sensation changes. In some instances, a herniated disc injury may compress the nerve or the spinal cord causing pain consistent with nerve compression or spinal cord dysfunction, also known as myelopathy.
Types Of Herniations :
- Posterolateral Disc Herniation – Protrusion is usually posterolateral into vertebral canal. Protruded disc usually compresses next lower nerve as the nerve crosses the level of disc in its path to its foramen. (Example: protrusion of L5 usually affects S1)
- Cental (posterior) Herniation – It is less frequent. A protruded disc above 2nd vertebra may compress the spinal cord itself or may lead to Cauda equine syndrome.
- Lateral Disc Herniation – Nerve root compression happens above the level of herniation. L4 nerve root is most often involved.
Stages Of Herniation :
- Bulging
- Protrusion
- Extrusion
- Sequestration
Etiology :
An intervertebral disc is composed of annulus fibrous which is a dense collagenous ring encircling the nucleus pulposus.
- Most common cause of disc herniation is the degenerative process (as humans age, the nucleus pulposus becomes less hydrated and weakens and may lead to progressive disc herniation).
- The second most common cause of disc herniation is trauma.
- Other causes include connective tissue disorders and congenital disorders such as short pedicles.
- Disc herniation occurs when part or all the nucleus pulposus protrudes through the annulus fibrosus. This herniation process begins from failure in the innermost annulus rings and progresses radially outward.
- The damage to the annulus of the disc appears to be associated with fully flexing the spine for a repeated or prolonged period of time.
- A herniation may develop suddenly, or gradually over weeks or months.
- Repetitive mechanical activities like twisting, bending, without breaks can lead to disc damage.
- Living a sedentary lifestyle, poor posture, obesity, tobacco abuse can also cause disc prolapse.
Signs And Symptoms :
- Severe low back pain, radiating pain.
- Walking can be painful and difficult.
- Valsalva Maneuver.
- Muscle spasm, tingling sensation, weakness or atrophy.
- Loss of bladder or bowel control.
- Some people may be asymptomatic.
- Slow and deliberate, tip-toe walking.
- Spine, trunk deviation.
- Antalgic or Trendelenburg gait.
- Paraspinal muscle spasm.
Treatments :
- Abhyanga (oil massage)
- Swedana (herbal steam therapy)
- Basti (medicated enema)
- Upanaha
- Pizhichil
- Kati Basti