Physiotherapy Case Study: PIVD with Lateral shift – Slipped Disc Treatment with Online Physiotherapy
by Physiotherapist Dr. Priyanka Dureja (PT) (BPT, MPT – Orthopedics, CSRD)
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Slipped Disc Treatment with Online Physiotherapy: ABSTRACT
Acute lower back pain had set in for Ms Simran suddenly after a routine mat workout. An MRI revealed prolapsed disc as the cause of lower back pain. PIVD, commonly known a Slipped disc or prolapsed disc can lead to chronic back pain, a shift in posture and body mechanics. In this case patient could not even walk or stand with equal weight on both legs due to her back pain and shift in body.
Lockdown due to Covid-19 further restricted her to continue slipped disc treatment at a nearby physiotherapy clinic. She opted to take ReLiva’s Online Physiotherapy for disc bulge related back pain, as this was the safest and convenient way to continue her PIVD treatment.
Slipped Disc Treatment with Online Physiotherapy: PREFACE
30year old female, Ms Simran (name changed) had been facing back pain intermittently over the last one year. But she took it casually. She would manage with home remedies for back pain like hot water fomentation, pain relief sprays, over the counter ointment and gels (muscle relaxant).
However on one particular occasion, after a routine mat workout, she happened to sneeze while getting up. She reports onset of severe back pain after the sneeze. The pain would occasionally extend to her legs right up to the knees. This back pain problem continued to trouble her. She was now unable to even stand straight. She decided to consult an orthopedic specialist who advised her to do an MRI. She was thereafter advised to take physiotherapy for PIVD treatment and correction of lateral shift.
Ms Simran consulted ReLiva physiotherapist Dr Priyanka Dureja (PT) at a ReLiva physiotherapy clinic near her. But she could not continue in-clinic treatment owing to the Covid-19 lockdown. We advised Ms. Simran to stay at home and undergo physiotherapy sessions online as it would be the most convenient and safest option available.
Lower Back Pain & PIVD History:
While taking the patient’s history for assessment of her back pain, she revealed having intermittent back pain for last one year. She would manage it with hot fomentation, ointments (muscle relaxant) and general exercises. But a specific episode triggered severe back pain, occasionally radiating to bilateral legs above knee. Pain in right leg above knee being more than that in left leg. She was also unable to stand straight and bear equal weight on both legs. She went to the orthopaedics department. Here she was advised to do an MRI, the findings of which suggested:
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Lower backache with bilateral lower limb pain (right>left)
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Diffuse symmetrical bulge at L4-L5 level with posterocentral annular fissure & posterocentral and right central disc protrusion, comprising the intervertebral foramina with mild traversing nerve root impingement
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Left asymmetrical bulge at L5-S1 level, compromising the intervertebral foramina, left > right with mild left exiting nerve root impingement.
The patient was advised physiotherapy for PIVD and left lateral shift in spine. She moved to online physiotherapy right at the start of the treatment as stability and correction of the shift were prime goals. Also sudden increase in her daily household chores was increasing the intensity of back pain.
PIVD Physiotherapy Assessment:
After the history was taken, we noted that there were no signs of red flags. No sensory involvement was noticed. The patient reported:
- Her back pain on VAS (visual analog scale to measure acute and chronic pain) as 7/10.
- Pain aggravated in standing and during rolling in bed.
- Inability to correct her posture.
As the patient was in acute shift, no further movement analysis was done for assessment as it would have unnecessarily increased the pain or disability.
At Reliva, physiotherapists use Education as a tool to empower patients for a sustained recovery. On the same lines, Ms Simran was explained about the biomechanics of the spine and how it is altered due to the disc bulge and nerve impingement. All these leading to slipped disc related back pain radiating to legs and the shift in her body. She was asked to take photo of her back (which her husband did for her) and the same were used to demonstrate the shift in her spine alignment. Same technique was used from session to session to help her understand the progress she was making throughout her physiotherapy treatment.
The patient was explained the line of her PIVD treatment. She was guided through the process of setting appropriate recovery goals.
- Short term goal of the treatment was to correct the posture and reduce pain.
- Long term goal of the treatment is:
- to get disc reduction
- to gain deep muscle strength to gain stability in the spine and
- to prevent any recurrence
Slipped Disc Treatment with Online Physiotherapy: APPROACH
Once the patient understood her condition and the cause of her back pain, she was progressed with regular sessions including targeted exercises.
PIVD Physiotherapy sessions: Frequency
Her sessions in general were schedules once a week with regular follow ups and updates in case of any discomfort or increase in back pain.
PIVD Physiotherapy Exercises
We took extra efforts to communicate that ‘Exercise is Medicine‘ and that it should be taken in the prescribed dosage and frequency religiously. She was instructed to do specific exercises daily – one set every two hours at the beginning of her treatment. She was also advised to use ice pack on the affected area twice a day.
[Related Reading : Ice or Heat, Which treatment to choose]
Her exercise programme for slipped disc treatment included movement therapy and kinetic control based exercises.
Based on periodic review of her pain on VAS and shift in position (photo of her back), we continued to close monitor her progress and revise her movements and back pain exercises appropriately.
Slipped Disc Treatment with Online Physiotherapy: CONCLUSION
By the end of her online physiotherapy treatment, the patient was happy to have achieved her immediate goal.
- The lateral shift in spine has been corrected
- Pain has remarkably reduced to 4/10 on VAS which comes only with prolonged standing.
Treating physiotherapist Dr Priyanka Dureja (PT) remarks, “Telerehab is an ideal solution to incorporate movement therapy for treatment of spine anomalies, when patient is unable to visit OPD for in-person physiotherapy sessions or in events like COVID-19 pandemic.”
If you, or someone you know would benefit from physiotherapy treatment and you do not have access to it right now, please register for an online physiotherapy session here or simply call us at +91 9920991584 and we will connect you with a physiotherapist best suited for your requirement.
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