Degenerative Disc Disease

By Jennifer Steele

We all know how important our spine is. It is our back bone, it protects the spinal cord and allows us to bend, twist and bears the weight of the body. Back pain can affect many people, of many ages and for many reasons. This means identifying the exact cause of the pain can be hard.

One of the most common causes of lower back pain and neck pain is Degenerative Disc Disease (DDD). Before looking at exactly what Degenerative Disc Disease is it is important to understand the basic anatomy of the spine. Then the causes, symptoms and treatment for DDD will be more clear and easier to understand. 

Anatomy of the Spine

The spine is made up of 33 irregular bones called vertebrae. Between each vertebra there is an inter-vertebral disc (IVD).

These discs act as cushions and absorb the shock up the spine.

Each disc has a similar construction to a car tyre. An outer ring which is made up of fibrous bands is called the Annulus. The inside of this band is filled with a gel like substance called the Nucleus Pulposus. The discs act like coiled springs, with the Annulus pulling the vertebrae together against the elastic resistance of the nucleus on the inside.

Degenerative Disc Disease

Degenerative disc disease is one of the most common causes of back and neck pain. It is used to describes the breakdown of the vertebral discs in the back. Most commonly it occurs in the cervical spine and the lower back. This is because these areas of the spine undergo the most motion and stress in everyday movements and postures and so are most susceptible to degenerative disc disease.

Degenerative disc disease is often misunderstood. The word ‘degenerative’ seems to imply that the symptoms will get worse with age. However, this is not the case, rather it is referring to the actual process of the vertebral disc wearing away and degenerating. It is not considered an actual disease but rather it is the result of wear and tear on the spine that leads to pain, instability and other problems. A small amount of disc degeneration is a normal part of aging and most people will experience small changes in their spine health. However, not all individuals will experience symptoms of Degenerative Disc Disease.

The gel filled nucleus of the inter-vertebral discs is filled mainly with fluid. While you lie down and sleep at night this fluid is absorbed and then  when you stand and move around in the day the fluid is pushed out. As we age the discs ability to reabsorb fluid is lost and so the discs become brittle and flat. Interestingly, the  flattening out is why we get shorter with age. 

As the discs loose fluid they start to degenerate. If excess stress and strain is placed on these discs it can cause many problems. Disc herniation’s, spinal stenosis, spinal cord injuries, and pinched nerves can all result from DDD. 

Causes

The most prominent cause of DDD is the natural affects of aging and the wear and tear of life of the spine. However, there are a few other factors more within our control that can increase the risk of developing it:

• Smoking
• Lack of exercise
• Obesity and carrying excess weight
• Car accidents
• Improper lifting techniques when carrying heavy loads
• Poor posture during activities of daily living

Symptoms

• Back or neck pain that can be a dull ache or sharp shooting. 
• Limited movement of the back and neck during everyday activities
• Referral pain into the arm or leg as a result of a pinched nerve
• Increased pain when bending forward, twisting or sitting. 

Treatment 

There is no way to ‘cure’ Degenerative Disc Disease. However, living with the pain and symptoms does not have to be the only way forward. There are both conservative, as well as more radical treatment options that can help limit the symptoms associated with DDD, as well as slow down any progression. 

The best place to start with treatment is to get an accurate diagnosis of the exact aspects of the back that are being affected. Determining whether there are disc herniation’s, stenosis, joint problems are all important before starting treatment. 

Rehabilitation and exercise

It might be hard to believe but rehabilitation and exercise are one of the most important treatment options to explore when dealing with DDD. Strengthening the core and pelvic stabilizers, loosing any excess weight and improving flexibility can all help reduce the amount of stress the spine is placed under. High impact, explosive exercise should be avoided as this will only increase the pressure on the spine and can exacerbate symptoms. 

Medication

Pain relief medications, such as Non-steroidal anti-inflammatory drugs may be prescribed by your doctor to help reduce the inflammation and pain in the back. However, caution should be taken when dealing with chronic pain and the use of NSAID’s as they can put pressure on the kidneys and stomach lining causing other problems if used for prolonged periods of time. Cortisone injections can also help with pain relief. It should be noted that even though medication is not a solution to DDD, it can help relieve symptoms enough to allow the individual to begin rehabilitation exercises and other treatment options. 

Other Options

Other treatment methods can include going to see a Chiropractor or Physiotherapist as they can assist with any manipulations and pain relief that is required.

The use of heat, ice and ultrasound therapy is also very common, as these will help reduce the inflammation in the back and decrease some of the pain. 

Surgical Treatment 

Surgical treatment is very rare and is usually only recommended if there is; disc herniation, persistent pain and nerve compression. Surgery will only be recommend by a Neurologist or Neurosurgeon after assessing scans and x rays.  

Surgical procedures can include:

• Spinal fusion:
  • Two vertebra are joined together with a bone graft
• Artificial disc:
  • An artificial disc is inserted between two vertebra
• Discectomy:
  • A portion of a disk is removed if it is compressing a nerve
• Partial removal of the vertebra:
  • A small portion of a vertebra may be removed if it is pinching a nerve

For more information about Degenerative Disc Disease and how to include safe rehabilitative exercises into your treatment plan contact us here.