Degenerative Disc Disease: Causes, Symptoms and Treatments.
Low back pain is the commonest cause of disability in people aged 45 or younger. While there are many possible causes, one of the most common is degenerative disc disease. Often this comes as a shock, especially when if it occurs when one is still young.
However, although the symptoms of degenerative disc disease might begin when one is still young, they might not necessarily get worse; in fact, for most people they improve. The degenerative process is ongoing, but this does mean that you will go on to experience severe problems or disabilities. As the disc degenerates, it may cause pain at times, but there is much that can be done to manage that pain and help prevent it from recurring.
Furthermore, pain from degenerative disc disease is more likely to occur in people aged between 30 and 50 than it is in people aged 60 or older, as by the time people reach 60 the condition tends to have stabilised, a process that can take 20 to 30 years. Usually, back pain in older people is caused by other conditions such as spinal stenosis.
The intervertebral disc consists of a central nucleus pulposus, a peripheral annulus brosus, and cartilage endplates at the vertebral junctions. The nucleus pulposus contains proteoglycans which absorption water which is essential to permit to disc to handle axial loads. When we are young, around 80% of the disc is water.
Disc degeneration tends to happen faster than most other aging processes, which is why it is often found in young adults. One of the reasons for this is that there is a very limited supply of blood to the discs, which means they are starved of the oxygen and nutrients that are needed for natural healing, in other words, the disc is not very good at healing itself.
The water content of the disc decreases with the result that assures in the nucleus pulposus and sometimes the annulus brosus potentially can occur. This is the start of a process that continues with the degenerative destruction of the disc, endplates, and vertebral bodies. It is a cascading process that can, but not necessarily does, result in disability.
Causes of Degenerative Disc Disease
There are several causes of degenerative disc disease. These include:
- Genetic as shown by twin studies the genes that code for specific collagens, interleukin and other proteins are implicated in the onset of the condition.
- Environmental although secondary to genetic causes environmental factors are important. In particular manual material work, frequent bending or twisting, and whole-body vibration are can cause the condition. There is also a relationship between degenerative disc disease and smoking which is thought to relate to reduced blood flow to the disc.
Typically, symptoms include pain, radiating pain and weakness. Back pain is likely to be dependent on the position and movement of the patient. Extension tends to relieve the symptoms while flexion makes them worse. If the pain is increased by extension, then this could indicate problems with the facet joints (facet arthropathy).
Sometimes other conditions can give similar symptoms to degenerative disc disease. These include pancreatic disease, aortic aneurysms, and kidney stones.
Initially, a physical examination will be carried out. This will be followed by x-rays which will help rule out other causes such as those mentioned above. X rays can also pinpoint other signs of degeneration including narrowing of disc space and sclerosis.
MRI and CT may also be used to provide more detail and a more accurate diagnosis.
Approaches to treating the condition include treatments that focus on removing the source of pain, for instance, the disc, reducing pain by stopping motion through vertebrae fusion, and more recent attempts to regenerate the disc using growth factors, gene therapy and stem cells (Taher, et al., 2012).
One problem with fusion is that it can lead to further degeneration of the spine and eventually to disability. It is almost always better to manage the pain associated with the condition and avoid surgery. Self-care is an important factor especially as when properly managed the pain associated with degenerative disc disease generally decreases as we grow older.
Physical therapy for degenerative disc disease
For most people, the best way of managing degenerative disc disease is through exercise and physical therapy. A regimen of controlled back exercises can help rebuild flexibility and strength in the back and improve the blood supply keeping the joints and tissue healthier.
Before starting exercises, you always see a physiotherapist who is also a spine specialist and who will be able to design exercises especially for you taking into account your level of pain and the specific diagnosis. Exercises are likely to include the following:
- Hamstring stretches are used to relieve tightness in the hamstring freeing motion in the pelvis and reduce stress across the lower back. The result is decreased pain intensity and reduced frequency of recurrences.
- Psoas Major muscle stretching relieves tightness in the Psoas Major muscle which can limit low back movement.
- Dynamic lumbar stabilisation exercises can help stabilise the spine and partially compensate for disc damage. These can be effective for reducing sciatica type pains.
- Low-impact aerobic exercises can improve your general level of fitness and reduce pain levels. Examples are swimming, other aquatic exercises, stationary bicycle exercises, and walking.
In many cases, degenerative disc disease sounds far worse than it really is. For most people, the condition is readily manageable and with exercise and self-care surgery can usually be avoided. For most people, the condition stabilises as they grow older.
For more information about Degenerative Disc Disease
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Taher, F., Essig, D., Lebl, D., Hughes, A., Sama, A., Cammisa, F., & Giradi, F. (2012, April). Lumbar Degenerative Disc Disease: Current and Future Concepts of Diagnosis and Management. Advances in Orthopedics, 7 pages