The best treatment of PLID/ Disc herniation / Disc prolapse in Bangladesh

Physiotherapy is a common treatment option for individuals with disc herniation, and ASPC manipulation center may offer various techniques to address this condition. It involves therapeutic exercises that aim to strengthen the muscles in the lower back and improve the condition of the spinal tissues and joints. The short- and long-term objectives of physical therapy for back pain are focused on reducing painful symptoms in the lower back and/or leg, enhancing low back function to enable independent performance of daily activities, improving spinal flexibility, range of motion, and creating a maintenance program to prevent recurrence of back problems.

The exercises target the entire kinetic chain, which includes body segments, joints, and muscles that work together to execute bodily movements. Physical therapy helps individuals recover the ability to carry out daily activities with minimal or no discomfort. Studies have indicated that physical therapy can lead to a significant improvement of up to 60% in lower back pain and other symptoms.

This article offers a thorough guide to therapeutic exercises for lower back pain. We provide guidelines to start a safe and effective exercise routine and step-by-step exercises to relieve pain. Our goal is to equip patients with the knowledge and tools to continue their exercise routine independently and achieve optimal health and wellness.

Our Goals

The goals of physiotherapy treatment for disc herniation of the lower back at an ASPC manipulation center may vary based on the individual patient’s condition and the specific treatment plan developed by the healthcare provider. However, some general goals of physiotherapy treatment for disc herniation of the lower back in an ASPC manipulation center may include:

• Pain relief: Physiotherapy may involve different techniques and exercises that help to alleviate the pain associated with disc herniation. The treatment may involve the use of ice, heat, or electrical stimulation to reduce pain and inflammation.

• Restore range of motion and mobility: Disc herniation can restrict the range of motion and mobility of the lower back. Physiotherapy aims to restore the normal range of motion and mobility of the spine through various exercises and stretches.

• Strengthen the muscles: Physiotherapy exercises help to strengthen the muscles in the lower back and core, which can help to support the spine and reduce the risk of future injuries.

• Improve posture: Poor posture can contribute to lower back pain and exacerbate disc herniation. Physiotherapy can help to improve posture and promote proper alignment of the spine.

• Prevent recurrence: Physiotherapy treatment may also focus on developing an exercise program that the patient can continue to perform independently to prevent the recurrence of disc herniation or other lower back problems.

Overall, our goal is to help patients suffering from PLID/Disc Herniation to regain their functional abilities and improve their quality of life.

Read more: How Physiotherapy Can Change Your Life: A Guide For Patients

In ASPC Manipulation center our physiotherapy experts will firstly take history of you and make an assessment to diagnose disc herniation and make a treatment plan in given procedure

• ASPC Manipulation Center doctors will ask questions about your lower back pain, including when and how it started, as well as any traumatic injury that may have occurred.
• You will be asked to describe the pain, including its location and what makes it better or worse.
• Medical conditions linked to disc herniation will also be discussed.
• Your home and work life will be evaluated to determine if physically demanding activities could put pressure on a lumbar disc.
• Medical history and previous treatments or injuries will also be discussed.
• If a family member has a history of lumbar herniated disc, it increases the likelihood of the condition.
• Depression or anxiety should also be part of the discussion, as it may be helpful in planning treatment.
• The information gathered will be used to create an individualized treatment plan to help alleviate your lower back pain.

Read more: A Simple Guide To Back Pain: How To Get Rid Of It In 4 Easy Steps

Physical assessment

1.Checking Neurological sign-symptoms

When conducting a neurological assessment, our specialists search for indications of sensory loss, such as numbness, and weakness in the leg and foot to determine the presence of any potential neurological problems. The patient may be requested to walk normally and on tiptoes to examine for foot drop, a condition resulting from weakened muscles that flex the ankles and toes. Our specialists also check for muscle strength and reflexes in other parts of the body, which may be slower than usual or absent.

2.Checking ROM

When assessing the range of motion (ROM) of a patient with a herniated disc in the low back, our experts may use a variety of techniques to evaluate the extent of the patient’s movement.

These methods may include:

Active range of motion: In this technique, the patient is asked to move their low back in different directions, such as bending forward, backward, and to the sides. The healthcare provider observes the patient’s movements and notes any restrictions or pain.

Passive range of motion: During this test, the healthcare provider moves the patient’s low back through different ranges of motion while the patient remains relaxed. This test can help to identify any restrictions or limitations in the patient’s movement.

Resisted range of motion: This test involves applying resistance to the patient’s low back during movement to assess the strength of the muscles supporting the spine.

3.Performing The leg raise test

Also known as the LaSegue test, is a common method used to evaluate for the presence of a herniated disc. During this test, the patient lies flat on their back while the physiotherapist gently raises the affected leg until the patient experiences pain. If pain is felt when the leg is raised between 30 to 70 degrees, it may indicate the presence of a lumbar disc herniation. Additionally, if raising the unaffected leg causes discomfort or pain in the affected leg, it suggests the impingement or irritation of a nerve root.

This test can be performed in various positions, such as from a seated position or while crossing the legs. The leg raise test remains a valuable tool in assessing the presence of a herniated disc and determining the most appropriate treatment plan.

4.Observe Gait Pattern

At ASPC Manipulation Center, our team of experts closely monitors the gait of patients with disc herniation. Gait analysis is a method of evaluating how a person walks, which can provide important information about their spinal condition. When a patient has a herniated disc, it can cause changes in their gait, such as limping or favoring one side of the body over the other.

By carefully observing a patient’s gait, our experts can identify any abnormal movement patterns, muscle imbalances, or other issues that may be contributing to the patient’s spinal condition.

5.Palpation of the affected area

Our experts conduct a thorough examination of the lumbar spine area in patients with disc herniation. This examination typically involves a physical evaluation of the patient’s back, including palpation of the affected area to identify any areas of tenderness or swelling.

In cases where there is inflammation present in the lumbar spine, the skin in the affected area may appear abnormal, such as reddened or warmer to the touch than the surrounding skin. The patient may also experience sensitivity or pain upon palpation of the affected area.

6.Reflex testing

In patients with disc herniation in the lower back, physiotherapists often perform reflex testing as part of the physical examination. Reflex testing involves the use of a reflex hammer to tap specific tendons or areas of the body, which elicits a reflexive response from the muscles. The physiotherapist will observe and assess the patient’s reflexes to determine if they are normal, brisk, or diminished.

In cases of lumbar disc herniation, the reflexes may be slower than normal or nonexistent due to nerve irritation or compression. The physiotherapist will typically test the reflexes of the patellar tendon (knee-jerk reflex), the Achilles tendon (ankle reflex), and the biceps and triceps tendons (arm reflexes) to evaluate the function of the nervous system.

7.Checking Muscle Power

Muscle strength testing is an important component of the physical examination for patients with lumbar herniated discs. Experts at ASPC will evaluate the strength of the muscles in the lower back, buttocks, legs, and feet, which can be affected by nerve compression or damage caused by the herniated disc.

8.Sensory status

Loss of sensory function in the leg is a common symptom of disc herniation in the lumbar spine. When a herniated disc presses on a nerve root, it can cause numbness, tingling, or a loss of sensation in the affected leg.

A physiotherapist can assess the sensory status of a patient with disc herniation by performing sensory testing. This typically involves using a variety of stimuli, such as light touch, temperature changes, or pinpricks, to test the patient’s ability to sense different sensations in the affected leg.

The physiotherapist may also ask the patient to describe any sensations they are feeling, such as a pins-and-needles sensation or a feeling of numbness. This can help the physiotherapist determine the location and severity of the sensory loss.

9.Imaging Test

Depending on the results of the physical assessment, our experts may suggest imaging tests to confirm a diagnosis of lumbar disc herniation. As mentioned earlier, X-rays, MRI, CT scan, myelogram, and EMG are some of the imaging tests that can help diagnose a herniated disc in the lower back. The type of imaging test recommended will depend on the individual’s specific symptoms and medical history.

• X-rays: X-rays use radiation to produce images of the bones in the spine. While they can’t directly show the herniated disc, they can help identify any abnormalities or conditions that may be contributing to the symptoms, such as spinal stenosis or osteoarthritis.

• Magnetic resonance imaging (MRI): An MRI (Magnetic Resonance Imaging) is a non-invasive diagnostic test that utilizes a combination of magnetic fields and radio waves to generate detailed images of the soft tissues in the spine, including the spinal cord and discs. It is widely regarded as the most precise imaging technique for identifying a herniated disc in the spine.

• Computed tomography (CT) scan: CT scans use X-rays to produce detailed images of the spine. They can provide more detail than X-rays and can help identify the location and extent of a herniated disc.

• Myelogram: A myelogram involves injecting a contrast dye into the spinal canal to make the nerves and discs more visible on X-ray or CT images. It is sometimes used when other imaging tests are inconclusive.

• Electromyography (EMG): EMG is a diagnostic test that measures the electrical activity in the muscles and nerves. It can help determine if there is nerve damage or irritation caused by a herniated disc.

Read more: 6 Tips for Relieving Pain From Herniated Discs or Disc Prolapse

Let’s discuss the treatment procedure of disc herniation at ASPC manipulation center

Tissue Manipulation

Soft and deep tissue manipulation is one of the treatment options that can be used to help reduce pain caused by a lumbar disc herniation. Soft tissue manipulation involves applying pressure techniques to the muscles, tendons, and ligaments surrounding the affected area. This can help relieve tension and improve circulation, which can reduce pain and promote healing.

At ASPC Manipulation Center, our physiotherapists are trained in various soft tissue manipulation techniques, including, myofascial release, and trigger point therapy. They will work with the patient to develop a treatment plan that is tailored to their individual needs and may include a combination of soft tissue manipulation, exercise, and other therapies. The goal is to provide pain relief and help the patient regain normal function as quickly as possible.

Mobilization

Joint mobilization is a type of manual therapy technique used by physiotherapists to treat various musculoskeletal conditions, including lumbar disc herniation. Joint mobilization involves passive movement of a joint through a range of motion in a controlled manner to reduce pain, improve joint mobility, and restore joint function. In the case of lumbar disc herniation, joint mobilization techniques can be applied to the affected vertebrae to reduce stiffness, restore joint mobility, and relieve pain. The physiotherapist may use different levels of force depending on the severity of the herniation and the patient’s tolerance level. The goal of joint mobilization is to improve the movement of the affected vertebrae and surrounding tissues, reducing pressure on the affected disc and facilitating healing.

Stretching techniques

In ASPC manipulation center our practitioners applies stretching techniques to help reduce the symptoms of disc herniation in the lower back. These techniques can alleviate pressure on the affected disc, reduce inflammation, and improve flexibility and range of motion.

• Knee-to-chest stretches are a popular stretching exercise that can be helpful for people with disc herniation in the lower back. This exercise involves lying on your back with your knees bent and gently bringing one knee towards your chest, holding it with your hands. This stretch can help to relieve tension in the lower back and stretch the muscles in the buttocks and hips.

• Hamstring stretches are another common exercise that can be beneficial for people with disc herniation in the lower back. This stretch involves lying on your back with your knees bent and slowly lifting one leg up and straightening it, holding onto the back of your thigh. This stretch can help to improve flexibility in the hamstrings and relieve pressure on the lower back.

• Piriformis stretches are also effective for people with disc herniation in the lower back. This stretch involves lying on your back with your knees bent and crossing one ankle over the opposite knee, gently pulling your knee towards your chest. This stretch can help to relieve pressure on the sciatic nerve and reduce pain in the lower back and hips.

• Cat-cow stretches and child’s pose stretches are also helpful for improving flexibility and reducing pain and stiffness in the lower back. These stretches involve moving the spine through a range of motion and stretching the muscles in the back and hips.

Manipulation

Manipulative Treatment is a form of manual therapy that is provided at the ASPC manipulation center for patients with lumbar disc herniation. This treatment approach involves the skilled application of various hands-on techniques to manipulate the spine and other joints in the body. Manipulative Treatment aims to restore joint mobility, alleviate pain, and improve overall function in patients with lumbar disc herniation.

The specific techniques used during Manipulative Treatment may vary depending on the individual needs of the patient. Spinal manipulation, also known as spinal adjustments, is a common technique used in Manipulative Treatment for lumbar disc herniation. This technique involves applying a controlled force to the affected joint in order to restore its normal range of motion and alignment. Other manual therapy techniques that may be used during Manipulative Treatment for lumbar disc herniation include mobilization, soft tissue therapy, and stretching exercises.

These techniques aim to reduce tension in the muscles and soft tissues surrounding the affected joint, promote healing, and improve overall flexibility and range of motion. Manipulative Treatment is generally considered to be safe and effective for the treatment of lumbar disc herniation. However, it is important to consult with a physiotherapy specialist to determine the best treatment approach for your individual needs, and to ensure that any Manipulative Treatment techniques are performed safely and effectively.

Applying Hot and cold

Hot and cold therapy can be an effective treatment approach for patients with lumbar disc herniation. At the ASPC manipulation center, hot and cold therapy is used as part of a comprehensive treatment plan to help alleviate pain, reduce inflammation, and improve overall function in patients with lumbar disc herniation.

Cold therapy, also known as cryotherapy, involves applying a cold compress or ice pack to the affected area. This technique helps to reduce inflammation and swelling, which can help to alleviate pain and discomfort associated with lumbar disc herniation. Cold therapy is typically applied for short periods of time, such as 10-15 minutes at a time, several times per day.

Hot therapy, also known as thermotherapy, involves applying heat to the affected area. This technique helps to increase blood flow to the affected area, which can help to reduce pain and promote healing. Hot therapy can be applied in various ways, including through the use of a heating pad, hot water bottle, or warm compress. It is important to note that hot therapy should be used with caution and should not be applied for extended periods of time, as this can increase the risk of further damage to the affected disc.

At the ASPC manipulation center, our physiotherapists recommend a combination of hot and cold therapy for patients with lumbar disc herniation. This approach involves alternating between hot and cold therapy, or using one type of therapy for a certain period of time before switching to the other. The specific approach used will depend on the individual needs of the patient and the severity of their symptoms.

Strength training Program

At the ASPC manipulation center, muscle strengthening exercises are often incorporated into the treatment plan for patients with lumbar disc herniation. Strong muscles are an important support system for the spine and can help to better handle pain and improve overall function.

However, it is important to approach muscle strengthening exercises with caution and to only introduce them when core stability has been fully regained and is under control. At this point, strength and power can be gradually trained to help improve overall function and reduce the risk of future injury.

It is important to note that power should be avoided during core stability exercises due to the combination of force and velocity, which can increase the risk of back problems and pain. Instead, patients at the ASPC manipulation center are provided with a customized exercise program that focuses on core stability and gradually progresses to include muscle strengthening exercises as appropriate.

The specific muscle strengthening exercises used at the ASPC manipulation center may vary depending on the individual needs and goals of the patient. Examples of exercises that may be included in a muscle strengthening program for lumbar disc herniation include squats, lunges, and leg presses.

Overall, muscle strengthening exercises can be an effective way to support the spine and improve overall function in patients with lumbar disc herniation.

In conclusion, the optimal treatment for PLID (Prolapsed Lumbar Intervertebral Disc) or disc herniation in ASPC Manipulation Center should be approached on a case-by-case basis, as the severity of symptoms and the degree of disc involvement can vary among individuals. A combination of conservative treatment strategies, such as medication, physical therapy, and lifestyle modifications, should be the first line of intervention. In cases where conservative management fails to yield significant improvements or if neurological complications arise, surgical options such as decompression or spinal fusion may be considered. Collaboration between healthcare professionals, including rheumatologists, orthopedic surgeons, and physiotherapists, is essential for developing a tailored treatment plan that prioritizes the patient’s comfort, functionality, and long-term outcomes.

FAQ’s

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Dr. M Shahadat Hossain

Physiotherapy Specialist at ASPC Manipulation Therapy Centre

BSPT (DU), MSc PT(DU), PhD-fellow (JU), Dip. in-Manipulation Therapy (Certified ETOMG-Belgium), McKenzie (A&B), Mulligan and dry Needling (India) Faculty Member of Bangladesh Health profession Institute (CRP), Savar.
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd

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