The document discusses Ayurvedic management of disc prolapse. It begins by describing the causes as repetitive mechanical activities, obesity, poor posture, injury, and genetics. Symptoms include severe back pain radiating to the lower limbs. Diagnosis involves physical exam and imaging tests. Conventional treatments include bed rest, anti-inflammatories, physical therapy, and injections. Ayurvedic management focuses on detoxification, strengthening tissues, proper nutrition and herbs, yoga, and therapies like oil massages. The goal is to reduce pain and inflammation, strengthen tissues, and prevent further deterioration.

1. AYURVEDIC MANAGEMENT
OF DISC PROLAPSE
Vaidya Ruchi Gulati MD(Ayu)
Sukh Ayurveda

2. GRDHRASI
 Pain originating from the regions of kati(waist)
gets referred or travels down to the
Sakti(thighs), Janu(knees), Gulpha(ankles),
and to the Pada gradually causing much
agony to the patient.

3.  Repetitive mechanical activities – Frequent bending,
twisting, lifting, and other similar activities without
breaks and proper stretching can leave the discs
damaged.
 Living a sedentary lifestyle – Individuals who rarely
if ever engage in physical activity are more prone to
herniated discs because the muscles that support
the back and neck weaken, which increases strain
on the spine.
 Traumatic injury to lumbar discs-
commonly occurs when lifting while bent at the
waist, rather than lifting with the legs while the
back is straight.
Causes

4.  Obesity – Spinal degeneration can be
quickened as a result of the burden of
supporting excess body fat.
 Practicing poor posture – Improper spinal
alignment while sitting, standing, or lying down
strains the back and neck.
 Tobacco abuse – The chemicals commonly
found in cigarettes can interfere with the disc’s
ability to absorb nutrients, which results in the
weakening of the disc.
 Mutation- in genes coding for proteins involved
in the regulation of the extracellular matrix, such
as MMP2 and THBS2, has been demonstrated
to contribute to lumbar disc herniation.
Causes

7. DISC LOAD IN DIFFERENT BODY POSTURE
When the spine is straight, such as in standing or lying
down,
internal pressure is equalized on all parts of the discs.
 While sitting or bending to lift, internal pressure on a disc
can move from 17 (lying down) to over 300 psi
(lifting with a rounded back).

8. Cellular and Biochemical Changes of the
Intervertebral Disc
 Decrease proteoglycan
content.
 Loss of negative
charged
proteoglycan side chain.
 Water loss within the
nucleus pulposus.
 Decrease hydrostatic
property.
 Loss of disc height.
 Uneven stress
distribution on the

9.  Disc herniation can occur in any disc in the spine,
but the two most common forms are lumbar disc
herniation and cervical disc herniation.
 The former is the most common, causing lower
back pain (lumbago) and often leg pain as well, in
which case it is commonly referred to as sciatica.
 Lumbar disc herniation occurs 15 times more often
than cervical (neck) disc herniation, and it is one of
the most common causes of lower back pain.
 The following locations have no discs and are
therefore exempt from the risk of disc herniation: the
upper two cervical intervertebral spaces, the
sacrum, and the coccyx.
Epidemiology

10.  Most disc herniations occur when a person is in their
thirties or forties when the nucleus pulposus is still a
gelatin-like substance.
 With age the nucleus pulposus changes ("dries out") and
the risk of herniation is greatly reduced.
 After age 50 or 60, osteoarthritic degeneration
(spondylosis) or spinal stenosis are more likely causes
of low back pain or leg pain.
 4.8% males and 2.5% females older than 35
experience sciatica during their lifetime.
 Of all individuals, 60% to 80% experience back pain during
their lifetime.
 In 14%, pain lasts more than 2 weeks.
Epidemiology

11.  The patient has severe back pain and is
unable to straighten up.
 Radiating pain to the buttock and lower
limbs and is associated with paraesthesia
or numbness in the legs or foot( sciatica)
and occasionally there is muscle
weakness.
 Both backache and sciatica are made
worse by coughing or straining.
 Cauda equina compression is rare but
may cause urinary retention and perineal
numbness.
Clinical Features

12.  The patient usually stands with a slight list to
one side(‘sciatic scoliosis’).
 Sometimes the knee on the painful side is held
slightly flexed to relax tension on the sciatic
nerve; straightening the knee makes the skew
back more obvious.
 All back movements are restricted, and during
forward flexion the list may increase.
Clinical Features

13. There is often tenderness in the midline of
the low back, and paravertebral muscle
spasm.
 Straight leg raising is restricted and painful
on the affected side; dorsiflexion of the foot
may accentuate the pain.
 Sometimes raising the unaffected leg
causes acute sciatic tension on the painful
side (‘crossed sciatic tension’).
With a high or mid-lumbar prolapse the
femoral stretch test may be positive.
Clinical Features

14. .
FEATURES OF CAUDA EQUINA SYNDROME
Bladder and bowel incontinence
Perineal numbness
Bilateral sciatica
Lower limb weakness
Crossed straight-leg raising sign
Note: Scan urgently and refer
urgently if a large central disc is
revealed.

15. Degeneration
 Loss of fluid in nucleus pulposus.
 Protrusion
 Bulge in the disc but not a complete rupture.
 Prolapse
 Nucleus forced into the outermost layer of the
annulus fibrosus- not a complete rupture.
 Extrusion
 the gel-like nucleus pulposus breaks through the
tire-like wall (annulus fibrosus) but remains within
the disc.
 Sequestration
 Disc fragments start to form outside of the disc
area.
Classification of Herniations

17. Types of Herniation
 posterolateral disc herniation –
 protrusion is usually posterolateral into vertebral canal,
compress the roots of a spinal nerve.
 protruded disc usually compresses next lower nerve as that
nerve crosses level of disc in its path to its foramen.
(eg.protrusion of fifth lumbar disc usually affects S1 instead.
 central (posterior) herniation:
 less frequently, a protruded disc above second lumbar
vertebra may compress spinal cord itself or or may result in
cauda equina syndrome.
 in the lower lumbar segments, central herniation may result
in S1 radiculopathy.
 lateral disc herniation:
 may compress the nerve root above the level of the
herniation
 L4 nerve root is most often involved & patient
typically have intense radicular pain.

18. Distribution of load in the intervertebral
disc.
(A) In the normal, healthy
disc, the nucleus
distributes the load equally
throughout the anulus.
(B) As the disc undergoes
degeneration, the nucleus
loses some of its
cushioning ability and
transmits the load
unequally to the anulus.
(C) In the severely
degenerated disc, the
nucleus has lost all of its
ability to cushion the load,

19. Location
 The majority of spinal disc herniation cases occur
in lumbar region (95% in L4-L5 or L5-S1).
 The second most common site is the cervical
region (C5-C6, C6-C7).
 The thoracic region accounts for only 0.15% to
4.0% of cases.

20. .
 posterolateral
herniation
between two
vertebrae will
actually impinge
on the nerve
exiting at
the next interverte
bral foramen
down.
 Occasionally an
L4/5 disc prolapse
compresses both
L5 and S1.

21.  Diagnosis is based on the history, symptoms,
and physical examination.
 At some point in the evaluation, tests may be
performed to confirm or rule out other causes of
symptoms such
as spondylolisthesis,degeneration, tumors, metastase
s and space-occupying lesions.
Diagnosis

22.  Finding include
positive straight
leg raise (lasegue
sign) which is the
most predictive
finding if it
reproduces leg
pain with L5 or S1
radiculopathy.
 as this finding has
low specificity;
however, it has
high sensitivity.
 Thus the finding of
a negative SLR
sign is important in
helping to "rule
out" the possibility
of a lower lumbar
disc herniation.
Physical Examination

23. X-Ray : lumbo-sacral spine;
 Narrowed disc spaces.
 Loss of lumber lordosis.
 Compensatory scoliosis.
MRI lumber spine;
 Intervertebral disc protrusion.
 Compression of nerve root.
CT scan lumber spine;
 It can show the shape and
size of the spinal canal, its
contents, and the structures
around it, including soft tissues.
 Bulging out disc.
Myelogram;
 pressure on the spinal cord or
nerves, such as herniated discs,
tumors, or bone spurs.
Imaging

24. Normal MRI

26. .

27.  Bed rest.
 Non-steroidal anti-inflammatory drugs (NSAIDs).
 Patient education on proper body mechanics.
 Physical therapy, to address mechanical factors, and
may include modalities to temporarily relieve pain
(i.e. traction, electrical stimulation massage).
 Oral steroids (e.g. prednisone or methylprednisolone).
 Epidural cortisone injection.
 Intravenous sedation, analgesia-assisted traction
therapy (IVSAAT).
 Weight control.
 Tobacco cessation.
 Lumbosacral back support.
 anti-depressants.
Conventional Medical
Treatments

28. Chikitsa Sutra
 Ama Pachan-reduce inflammation and pain
 Shodhan- Detoxification & elimination of toxins
from the body
 Brmhanam- Prevention of further deterioration
in joints and rejuvinates the damaged
cartilages

29. Management at Sukh Ayurveda
 Detox Panchkarma Therapies
 Proper Nutrition
 Ayurveda Herbs
 Lifestyle and Daily Routine
 Yoga
 Strengthening Body’s Self Repair Mechanisms

30. Detox Panchkarma Therapies
 Vasti
 Kayaseka or Pizhichil
 Patrapinda Swedanam or Ilakzihi
 Shalishasti Pinda Svedanam or NavraKizhi
 Kadi vasti

31. Pizhichil
 Procedure: Warm
healing oil is poured
over the body in a
rhythmic pattern. A
gentle massage
revives the body.
 60 minutes

32. Patrapinda Swedanam or
Ilakzihi
 Procedure: Herbal
leaves and spices are
bound into a bundle,
a herbal bun, and
soaked in warm
medicated oils. A
skilled therapist
applies this to your
body with focus on
painful areas.
 60 minutes

33. Shalishasti Pinda Svedanam/Navra
Kizhi

34. Kadi vasti
 Procedure: Specially
prepared, warm
medicated oil is poured
over the lower back and
then kept in place by a
flour dough boundary.
Also, a full body oil
massage is done for
complete healing. . A
series of treatments are
recommended to treat
the back pain and spinal
disorders.
 75 minutes

35. Proper Nutrition
 Proper use of spices
 Herbal preparations to improve digestion
 Proper spacing between breakfast, lunch and dinner
 Favoring foods which stimulate digestion
 Reducing consumption of foods that depress digestion
 Proper food combinations to avoid indigestion
 Non-dietary regiments to improve digestive strength including
exercise, specific yoga asanas etc.

36. Ayurveda Herbs
 Maharasnadi Kashayam
 Sahacharadi Kashayam
 Tryodashang Guggulu
 Shefalika patra Kashyam

37. Lifestyle and Daily Routine
 Do not bend, lift, or sit in a soft, low chair; the pain
will get worse.
 The affected individual may feel better lying on his
or her back on a firm surface with a pillow under
his or her knees. Another option is lying on one's
side with a pillow between the knees to keep the
back straight.
 Take it easy, but do not simply lie in bed because
this has been shown to actually worsen the
condition. Do activities one is able to tolerate, and
do not expect to feel better overnight.

38. Yoga
Shallabh asana
Nauka asana
Bhujang asana

39. Sukh Ayurveda Outcomes
 Reduction in pain especially the radiating pain
 Relief in burning sensation & numbness
 Increased Range of Movements (ROM)

40. Other Ayurveda Treatments
 Marma Chikitsa
 Rakta mokshan