Disc Herniation

Question 1

Disc Herniation Overview

Answer 1

• Nucleus pulposus is displaced from intervertebral space
• Common cause of back pain
• Patient often remembers inciting event that causes back pain, can be weakness or sensation changes
• Imaging — seen on MRI
• PT is key, surgery is last resort

Question 2

Disc Herniation Cause

Answer 2

• Fully flexing spine for repeated or prolonged period of time (twisting, bending)
• Can happen suddenly or gradually
• Degenerative process is most common
• Second most common cause is trauma

Question 3

Disc Herniation Types

Answer 3

• Posterolateral — protrusion is posterolateral into vertebral canal, compresses next lower nerve (L5 protrusion affects S1)
• Lateral — nerve root compression happens above level of herniation

Question 4

Disc Herniation Examination

Answer 4

• Dermatomes / sensation
• Severe LBP
• Radiating pain
• Walking painful and difficult
• Loss of bowel and bladder control
• Some people asymptomatic
• Spine and trunk deviation
• Muscle spasm, tingling, weakness, atrophy

Question 5

Cervical Disc Herniation Special Test

Answer 5

• Spurling
• Distraction
• Upper limb tension test
• Shoulder abduction test
• Tinels sign

Question 6

Lumbar Disc Herniation Special Test

Answer 6

• SLR test
• Prone knee bend
• Reflexes
• Sensory testing

Question 7

Disc Herniation PT Management

Answer 7

• Aerobic activity
• Directional preference (McKenzie approach)
• Flexibility exercises
• Proprioception, coordination, balance
• Strengthening
• Core stability exercises
• Healthy weight
• Best sleeping position is sidelying with legs bent in semi fetal position