PIVD Prolapsed Intervertebral Disc Physiotherapy and it's management PIVD Definition Biomechanics Causes Disease progression and pattern Clinical symptoms Investigation Physical findings Management Conservative management Surgical management Physiotherapy management

2. By Dr Dharma Patel
(DPT)

5. THE IV DISC CONSISTS OF THREE DISTINCT
COMPONENTS :
1.THE CARTILAGE END PLATES
2.NUCLEUS PULPOSUS
3.ANNULUS FIBROSUS.
THE CARTILAGE RING ARE THIN LAYERS OF
HYALINE CARTILAGE BETWEEN TWO
ADJACENT VETEBRAL BODIES AND DISC
PROPER.

17. CONGENTIAL
DEVELOPMENTAL
•POOR NUTRITION
•ACCUMATED TRAUMA : SPORTS,AUTOMOBILE INJURY
LEAD TO WEAKING OF I.V.DISC
•BIOMECHANICAL FACTORS
•POSTURE
•REPITITIVE MICROTRAUMA , FLEXION (COMPRESSION
INJURIES) , TENSIONAL INJURIES

20. IT IS SEQUENCE OF CHANGES OCURRING IN THE DISC WHICH LEAD TO
PROTRUSION OR EXTRUSION OF NP THROUGH A RENT IN THE AF.
THESE CHANGES CONSISTS OF THE FOLLOWING :
A) NUCLEUSDEGENERATION : degenerative changes occur in the disc
before displacement of the nuclear material. these changes are:
(i) Softening of the nucleus and its fragmentation
(ii) Weakening and disintegration of the posterior part of the annulus

21. B) NUCLEUS DISPLACEMENT : the nucleus is under positive
pressure at all the times. When annulus become weak ,either
because a small area of its entire thickness has been
disintegrated spontaneously or because of the injury , the
nucleus tends to bilge through the defect. This is known as disc
protrusion.
This tendency is greatly increased if the nucleus is degenerated
and fragmented. Finally the nucleus comes out of the annulus ,
and the underthe post” longitudinal ligament though it has not
lost contact between with parent disc. This is called as disc
extrusion.
Once the disc is extruded it cannot go back and PLL is not
strong enoughto prevent the nucleus protruding further. So,
the extruded disc, may loose its contact with parent disc. The
sequestrated disc may come to lie behind the PLL or may

23. C) STAGE OF FIBROSIS : this the stage of repair.
the begins alongside of degeneration . The residual
nucleus pulposus becomes flattened , fibrosed , and
finally undergoes calcification. At the same time, new
bone formation occurs at the point where the PLL has
been stripped from the vertebral body and
spurformation occurs.

43. IN CASE OF Cx PIVD :
a) Foraminal compression / spurling test
b) Distraction test
c) ULTT(upper limb tension test)
d) Shoulder abduction test
e) Tinel’s sign
(a)

44. IN CASE OF Lx PIVD:
a) SLR
b) Lasegue’s test
c) Bowstring test
d) Prone knee bending (PKB) test
e) Sensory impairment (over dermatomes motor
weakness over myotomal distraction)

45. (d) (e)

46. (b)
(c)
(e)
(d)

47. ASSESSMENT TREATMENT
ASSESSSMENT :
•POSTURE (rigid posture , loss of curve spine( i.e flattened back
in lumbar spine , posterior pelvic tilt , sciatic scoliosis may present
.)
•MOVEMENT : trunk flexion (may be painful , flexion may produce
pain .)
•TENDERNESS : along midline or lateral to spinous processes.

49. Self Shift correction
The patient stands with their shoulder
against the wall. The bend their elbow
and place their upper arm against their
side. They then need to have their feet
approximately 12-18 inches away from
the wall, this allows more motion of the
hips to the wall. They then glide their
hips toward the wall.

50. CONSERVATIVE OPERATIVE

53. Surgeries
• Discectomy
• Microdiscectomy
• Laminectomy
• Nucleoplasty
• Artificial disc replacement
• Foraminotomy