Degenerative Disc Disease and Back Pain

The spinal discs are a unique structure. They are round(ish) in shape, with a flat top and bottom that attach securely to the vertebra above and below. The discs consist of 2 parts, a tough outer ring (anulus fibrosis) and a softer, fibrous inner component (nucleus pulposus).

There are 23 spinal discs in our spinal column. Their primary function is to act as a shock absorber between the bones in our spine (the vertebra) to stop them banging or rubbing against each other. They also hold the vertebra together and allow movement between them.

The spinal disc itself has very few nerve endings and no blood supply. Without a blood supply the disc is unable to repair itself, and this means that pain coming from a damaged disc can last for years.

As we age, the spinal discs start to dehydrate (the discs are 80% water at birth!). As a result of this loss of water over time, the discs start to stiffen. This means they are less able to adjust to the compression forces of every day activities. Although this is considered a part of the natural ageing process, in some individuals, it can cause pain.

This is known as Degenerative Disc Disease.

It is one of the most common causes of lower back pain. However it is also the most misunderstood.

That is partly because few medical professionals agree on exactly what a diagnosis of Degenerative Disc Disease means, and also when exactly, it is the cause of back pain. The symptoms of Degenerative Disc Disease can be quite varied, and this just makes it even more difficult to diagnose.

It’s also important to note that you can have a problem with the disc (such as degeneration or even a bulge) and not have any pain at all. In fact a relatively high percentage of the population over the age of 40 has a disc disorder that can be seen with MRI studies (disc bulges and annular tears are very common). This does not mean that you will experience pain or any other symptom.

Maybe not surprisingly, Degenerative Disc Disease is almost universal in the population. The discs can start to show degenerative changes as early as in our 20’s. Most people will have varying degrees of mild to moderate Degenerative Disc Disease by the time they are in their 30’s. Some are even severe by this age.

Strangely though, not everyone experiences pain. One person may have crippling pain, whilst someone else may have no pain at all. This is one of the difficulties of knowing when, and how to treat Degenerative Disc Disease.

Signs of Degenerative Disc Disease:

Although it varies widely, signs of Degenerative Disc Disease generally follow a pattern.

Pain in the midline (not off to one side)

Intermittent back pain (flares up from time to time) but generally does not get worse over time.

Pain is often worse with weight bearing, and improves with lying down.

Pain aggravated by physically demanding activity.

Pain aggravated by forward bending, particularly for extending time periods (sitting, working at a bench).

The pain from Degenerative Disc Disease is due to a combination of inflammation and instability of the spinal segment (which puts further stress on the surrounding tissues).

As the discs degenerate, they lose water and start to shrink, losing height and the ability to flex and absorb pressure. This process is often sped up as a result of poor posture, sedentary lifestyle, lots of sitting, and incorrect movement patterns. It is even worse if there has been an injury, particularly if a twisting injury has damaged the disc at some point.

The shrinking disc is a telling sign of Degenerative Disc Disease. It is easily visualised on X-rays, where you can see a decrease in the space for the disc.

Treatment Options for Degenerative Disc Disease.

Medications such as pain killers and anti-inflammatories can relieve the pain, but do not fix the underlying problem.

Spinal surgery, usually fusion, has unreliable outcomes and a long recovery time. Surgical intervention of any kind is fraught with risks and can lead to further complications down the line. In severe cases this may be the only option, but all other possible avenues should be tried first.

Chiropractic manipulation can increase spinal range of motion, relieve nerve pressure, restore blood flow and reduce muscle tension. It is low risk and has a very good success rate.

Ultrasound and massage can help to restore blood flow and reduce muscle tension.

A specific exercise program designed to progressively stabilise the spine and increase flexibility is often the only way to achieve long-term healing for most sufferers of Degenerative Disc Disease.

Hot and cold therapy, losing weight and quitting smoking are all known to be beneficial as well.

Exercises for Degenerative Disc Disease.

The best exercises for DDD are stretching exercises to help to improve spinal flexibility. Walking is also of great benefit.

Low Back Stretch

Start in a kneeling position, then sit back onto you feet.

Stretch your arms out in front of you along the floor.

Feel the stretch in your low back and hold for 10 seconds.

Move back onto your hands and knees, then gently lift one leg behind you as far as you comfortably can.

Kneeling Leg Raise

Start in a kneeling position, then slowly raise one leg up behind you.

Hold for 10 seconds then do the same on the other side.

Back Extensions

Lie on your tummy, and gently lift your head and shoulders off the floor using your back muscles and propping your self up on your elbows for 10 seconds.

Begin this one very carefully and slowly as it can be quite painful at the start.

This is also good to strengthen the abdominal muscles, which are important spinal stabilisers.

First off, try this in a standing position with your hands on your hips, and just gently arch backwards over your hands.

If you have any pain aggravation then do not do this exercise. If it is okay, after doing this for 2-3 days you can progress to doing extension exercises on the floor.

It is important to obtain an accurate diagnosis from your health care professional before starting any exercises, particularly if you are suffering with back pain. You have to be very careful before attempting any exercise regime. There is a real possibility that you could aggravate your condition if you do the wrong thing.