Disc Prolapse

The vertebrae are cushioned by intervertebral discs which act as shock absorbers for the spine. The normal intervertebral disc is composed of a nucleus pulposus, at the center, surrounded by a fibrous ring known as annulus fibrosus. The nucleus pulposus is a soft jelly like substance that is well hydrated and acts like a shock absorber. Herniated disc is a condition in which the outer fibrous annulus of the intervertebral disc is damaged causing the soft gelatinous material, from the center, to protrude through the ruptured annulus resulting in nerve root and/or spinal canal compression. Disc prolapse is also known as a bulging disc, herniated disc slipped disc or ruptured disc.

Symptoms of disc prolapse: The predominant symptom of a disc prolapse is pain, which can range from mild to severe and is usually aggravated by movement. The most common signs and symptoms of a herniated disc are as follows:

• Disc prolapse in the lower back causes back pain that radiates to buttocks and legs
• Disc prolapse in the upper back causes neck pain that radiates to the shoulders and upper arms
• Numbness or tingling sensation
• Muscle weakness
• Rarely, bowel and bladder dysfunction

Causes of disc prolapse: Discs have soft, gel-like centers and a firmer outer layer, like a jelly doughnut. With time, the outer layer weakens and can crack. A herniated disk happens when the inner “jelly” substance pushes through the crack. The leaked material may press on nearby spinal nerves. Several factors can contribute to a disc rupture, including:

• Aging.
• Excessive weight.
• Repetitive motions.
• Sudden strain from improper lifting or twisting.

Diagnosis of disc prolapse: An accurate diagnosis and an effective treatment plan are important for a successful outcome. Your doctor will usually diagnose a disc prolapse based on your history of symptoms along with a physical examination and neurological examination. Your sensations, reflexes, and the strength of the muscles are evaluated. Imaging tests such as X-rays, MRI or CT scan may be used to confirm the diagnosis of a disc prolapse. X-rays of the spine may be taken to locate the collapsed disc space. A CT and MRI scan provides detail of the discs, nerve roots, and bone structures in the spine.

Treatment of disc prolapse: You may need more advanced treatments if your symptoms aren't getting better. Your healthcare provider might recommend:

• Medication: Your provider may prescribe an anti-inflammatory pain reliever or muscle relaxant.
• Spinal injections: Called an epidural or nerve block, a spinal injection is a shot of steroid medication directly into your spine. The medication reduces swelling and inflammation of the nerve from the disc prolapse. This will allow your body to heal and return to activity faster.
• Surgery: In rare cases, a large disc prolapse might injure nerves to the bladder or bowel. That may require emergency surgery. For nonemergency cases, surgery is an option when other treatments fail. There are various ways to perform spinal decompression surgery, but the goal is to relieve pressure on the nerve.
• Physical therapy: A physical therapist teaches you an exercise program to help relieve pressure on your nerves. Exercise loosens tight muscles and improves circulation.

Exercise of disc prolapse: General exercise is very important with a prolapsed disc. It can help lessen the pain by increasing the muscle strength for the muscles that support the spine. 

Although it is not known if specific spinal exercises are better than generally keeping fit, a physiotherapist can advise on the best exercises for an individual.

• Aerobic activity (eg, walking, cycling)
• Directional preference (McKenzie approach)
• Flexibility exercises (eg, yoga and stretching)
• Proprioception/coordination/balance (medicine ball and wobble/tilt board),
• Strengthening exercises.
• Motor control exercises MCEs

Effective management of Disc Prolapse at Spine Physiotherapy & Rehabilitation Centre (SPTRC) in Shyamoli requires teamwork among medical professionals and patients, which in turn improves the patients' quality of life.

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