Degenerative Disc Disease (DDD) is one of the most common causes of lower back and neck pain, and also one of the most understood. Degenerative disc disease refers to pain related to the back or neck caused by the wear and tear on a spinal disc. In some cases, degenerative disc disease also causes weakness, numbness, and hot, shooting pain in the arms or legs (known as ‘radical arm pain’). This disease typically consists of low-level chronic pain with intermittent episodes of more severe pain. Painful disc degeneration is common in the neck and lower back. These areas of the spine undergo the most motion and stress and are the most susceptible to disc degeneration.
The term “degenerative” understandably implies that symptoms will worsen with age. However, the term does not refer to the symptoms but rather describes the process of the disc degenerating over time.
Despite what the name suggests, degenerative disc disease is not technically a disease, but a condition in which natural, age-related wear-and-tear on a disc causes pain, instability, and other symptoms. This condition normally does not result in long-term disability, and most cases can be managed using non-surgical treatment methods.
Overall, disc degenerative disease is a natural part of aging, and over time everyone will exhibit some changes in their discs. However, a degenerative disc does not always cause symptoms to develop. In fact, degenerative disc disease is quite variable in its nature and severity.
Causes & Symptoms
A degenerating spinal disc does not always lead to pain or other symptoms – because the disc itself has very little innervation, the pain usually occurs when the degenerating disc affects other structures in the spine (such as muscles, joints, or nerve roots).
Pain associated with degenerative disc disease generally stems from two main cause factors:
Inflammatory proteins from the disc space interior may leak out as the disc degenerates, causing swelling in the surrounding spinal structures. This inflammation can produce muscle tension, muscle spasms, and local tenderness in the back or neck. If a nerve root becomes inflamed, pain and numbness may radiate into the arm and shoulder.
Abnormal micro-motion instability
The cushioning and support a disc typically provides decreases as the disc’s outer layer degenerates, leading to small, unnatural motions between vertebrae. These micro-motions can cause tension and irritation in the surrounding muscles, joints, and / or nerve roots as the spinal segment becomes progressively more unstable, causing intermittent episodes of more intense pain.
Generally, both inflammation and micro-motion instability can cause lower back or neck muscle spasms. Muscle spasms in the body attempt to stabilize the spine, therefore, muscle tension and spasms can be quite painful and are thought to cause the flare-ups of the intense pain associated with degenerative disc disease.
Other common symptoms of this condition include:
- Pain that is much worse when sitting – whilst seated, the discs of the lower back have three times more load on them than when standing.
- Pain that worsens when bending, lifting, or twisting.
- Feeling better whilst walking or even running than whilst sitting or standing for long periods of time.
- Feeling better changing positions often or lying down.
- Periods of severe pain that come and go – these could last from a few days to a few months before recovering. They can range from nagging pain to disabling pain. Pain can also affect the low back, buttocks, and thighs or the neck, depending on where the affected disc is, radiating to the arms and hands.
- Weakness in the leg muscles or foot drop; a possible sign of damage to the nerve root.
- Numbness and tingling in the extremities.
Who Can Get Degenerative Disc Disease?
By understanding some of the risk factors, you may be able to slow down the degenerative process. Here are some of those risk factors that could lead to degenerative disc disease:
Family history / Genetics
Patients who have parents or other family members with back pain or degenerative disc disease have a significantly higher chance of developing this condition.
Degenerating discs are a part of the aging process, so in time, we all experience various levels of disc degeneration.
The nicotine and other dangerous chemicals in tobacco smoke keep the discs from absorbing essential nutrients from the blood. This can dry out the discs and even increase the chances for a herniated disc; when the inner layer breaks through the outer layer of the disc.
Inactive individuals tend to have more back pain – prolonged sitting can put a strain on the lower back and spinal discs.
Extra body weight often places stress on the spine, back, and pelvis, thus triggering back pain. Moreover, added weight shifts the pelvis forward, causing the spine to curve unnaturally; this added strain and awkward posture can damage the discs.
Occupations & work activities
Careers that involve heavy manual labour such as lifting and pulling can wear down the discs. In addition, damaged discs are common for those who participate in sports where there is heavy stress on the spine. These activities include running, football, rugby, hockey, wrestling etc. Repeated impacts to the spine can cause an annular tear or damage to the disc’s outer layer in which hastens the degenerative process.
Once a disc is injured due to a fall, impact, or accident, the blood supply leading to the disc is often compromised. This slows the delivery of essential nutrients and oxygen to the damaged tissues. Injuries can cause a disc to wear down relatively quickly.
How Does It Affect You? How Serious Is It?
It is always important to note that disc degeneration may lead to or hasten the onset of additional spinal conditions, such as the following:
- Spinal stenosis, a form of spinal degeneration that leads to nerve root or spinal cord pinching.
- Osteoarthritis in the spine, changes in the facet joints at the back of the spine that occur as a result of degeneration.
- Spondylolisthesis, in which one vertebral body slips forward on another due to facet joint degeneration.
- Scoliosis, where discs degenerate in a lopsided fashion and a somewhat ‘curve’ may develop over a period of time.
Recommended Treatment & Rehabilitation
Firstly, a degenerative disc disease diagnosis begins with a medical history review. It is collected to detail current symptoms, including when the pain began, if the pain is accompanied by other symptoms such as numbness or tingling, and if the pain started after an injury. A medical history also gathers information on regular physical activity, sleep habits, and past injuries. Secondly, a physical exam tests the spine’s range of motion and strength. A physical exam may include feeling by hand along the lower spine to locate areas of tenderness, inflammation, or physical abnormalities. In addition, movement tests that determine which motions or positions alleviate or worsen pain may help indicate where the pain is produced in the spine.
A definitive diagnosis for degenerative disc disease could require an MRI scan to ensure that any other issues are not associated with the pain due to the current condition, such as a fracture or disc herniation. If surgery is needed, an imaging test is required prior to the procedure to accurately locate the degenerated disc and plan the surgery. Studies have shown that MRI findings of mild or significant disc degeneration are found on scans of patients with severe pain and minimal or no pain. Additionally, many painful conditions may not show up on an MRI, such as a tear in the disc’s outer rings or some cases of herniated discs. For this reasoning, a diagnosis cannot rely solely on imaging tests and must be used in combination with a medical history and physical examination.
Physiotherapy is often suggested or prescribed to help maintain healthy mobility in the spine. A thorough lower back exercise program should include a combination of the following:
Stretching for muscles in the lower back, hips, and pelvis, as well as the hamstring muscles. Tightness in these muscles places more pressure on the lumbar spine and contributes to low back pain.
These build lower back and abdominal muscles to maintain healthy postures and better support the spine. Strengthening exercise programmes might include a customized physiotherapy program, dynamic lumbar stabilization, or others.
Low-impact aerobic exercise
This helps elevate the heart rate to improve circulation and deliver nutrients and oxygen necessary for healing the body’s tissues. Examples of aerobics that are gently on the spine include walking, swimming, and water aerobics.
Other specific exercise examples include:
Place your foot onto a raised surface such as a chair or staircase step. Keep your back straight, then gradually bend your torso towards your raised foot unit you feel a stretch. Finally, hold this position for at least 30 seconds and then change to the opposite foot. It is recommended to repeat this exercise three more times.
Firstly, start on your hands and knees, hands below the shoulders, and knees below the hips. Secondly, gently arch your back by lowering your neck down towards your chest as far as you feel comfortable enough. Lastly, hold for 30 seconds, then reverse the motion as you’re elevating your neck toward the ceiling and arching your back in the opposite direction. Hold this position for 30 seconds before repeating the stretch three times a day.
Lie down on your stomach with your torso raised up and arms extended outward. With your palms planted against the ground, begin raising your neck and torso higher until you feel the stretch in your lower back and abdominal muscles. Hold this position for at least 30 seconds and relax before repeating this stretch three times a day.
Overall, physiotherapy programmes are normally tailored on a case-by-case basis. In addition, making small adjustments to everyday activities can effectively lessen pain. For example, wearing a back brace while lifting, or avoiding twisting while lifting, can prevent pain from flaring up due to overuse.
Alternative & Homeopathic Treatment
Homeopathic treatment for degenerative disc disease focuses on minimizing pain, stabilizing the spine, and improving or maintaining mobility. Initial pain management methods for this condition typically include a combination of the following:
- Over-the-counter pain medications – Aspirin, ibuprofen, or naproxen are all common pain medications that can help relieve inflammation that contributes to discomfort, stiffness, and nerve root irritation.
- Heat & Ice application – Applying heat to the lower back improves circulation, which reduces muscle spasms and tension and improves mobility. Ice packs can reduce inflammation and numb mild pain. It can be helpful to apply heat before physical activities to relax the muscles and to apply ice after activity to minimize inflammation.
- Massage Therapy – Massage therapy can reduce tension and spasms in the lower back muscles, reducing pressure on the spine and alleviating pain. Additionally, massage therapy can improve circulation, proving healing nutrients and oxygen to tense muscles.