Degenerative Disc Disease
by Andrea Renshaw, M.P.T.
Having degenerative disc disease does not mean that pain will naturally get worse over time. In fact, the back pain typically experienced with degenerative disc disease tends to get better as time goes on.
This article will discuss the current thinking regarding degenerative disc disease and outline the causes, symptoms and common remedies and solutions.
The term "degenerative" is usually interpreted to mean "progressive" and although disc degenerative will most likely progress, the low back pain associate with it improves in most cases.
The use of the word "disease" also creates confusion, since this is not a disease process.
There seems to be no concrete consensus among medical practitioners about what constitutes DDD, which means that you might naturally be confused about what it means.
Degeneration of the intervetebral disc, which sits between every vertebrae of the spine, is a natural part of aging, but back pain as a result is not. The age at which DDD develops and the symptoms that it produces can vary greatly between individuals.
So just what is degenerative disc disease? The disc is comprised of two layers: an outer fibrous layer (annulus) and an inner gel-like layer (nucleus), much like a jelly donut.
In DDD, the outer layers of the disc get worn down and damaged as a result of the natural aging process, allowing the nucleus to penetrate along small fissures or cracks. This causes the disc to narrow, leaving less space and less shock absorption between the vertebrae.
What Causes Degenerative Disc Disease?
Wear and tear on the discs in the lower back are the cause of Degenerative disc disease. Degenerative disc disease usually occurs in active people between the ages of 30 and 50 and takes a long time to develop - about 20 - 30 years.
Muscle and postural imbalances over time create the environment that result in disc degeneration. Damage usually occurs in areas of the spine that take the most load - the lower back and neck.
Pain is caused in two ways: First, the nucleus contains proteins that can migrate into the disc space and cause inflammation. This causes back pain and sometimes pain into the hips and legs due to nerve irritation.
Second, the outer layer of the disc that is responsible in part for controlling spine movement can no longer stabilize the smaller "micromotions" of the spine. This causes muscle spasm as a reflex response to protect the spine. Although this is a protective response, muscle spasm is painful.
As the process progresses, the release of inflammatory proteins decreases and the spine stiffens, creating natural stability. This is the reason why back and neck pain usually get less over time.
An example of how Degenerative Disc Disease can occur in the spine
You have always been active. Perhaps you played basketball, ran track or played another sport in school. You may have had back pain on and off over the years. As you reach your 30s or 40s, you notice that the pain is either more severe, or has started to radiate towards
your arm or leg. You can't find a comfortable sitting position and exercising too much often makes your pain worse.
Your symptoms may have appeared relatively quickly, but you have been laying the groundwork for disc damage for many years. As your disc degenerates and you continue to place more compressive force through it, you are creating more damage. One day, there is enough wear and tear on the disc that pain results - like when you get a hole in your sock.
Common Remedies and Solutions
These therapies reduce symptoms, but do not address the cause of DDD. The long term approach for controlling DDD includes spinal stability training, balancing postural and movement problems and learning how to self-monitor activities that are associated with pain triggers.