Lower back pain often hits when we get a little older. One of the reasons for this is that we begin to lose water throughout our bodies and as tissues become less hydrated the ones that have the lowest natural blood supply tend to be affected the most like our joints and the intervertebral disc. The disc loses its blood supply early in life and needs a constant exchange of fluid to remain healthy and hydrated. As the cartilage structure of the disc becomes less stable the disc begins to deteriorate. This condition is called degenerative disc disease.
The disc can begin this early degeneration and never cause pain. That’s because the disc for the most part is not pain sensitive except for the very outer 1/3rd. The degenerative process doesn’t create inflammation early on so the first signs of this may be seen on x-ray, showing a decrease in disc height or an MRI on the T2 image showing a darker disc.
The pain associated with this condition usually comes in the later stages. Once the disc becomes more fragile it begins to lose elasticity and the inner material that is inherently higher in water content and thus much softer can begin to migrate through the small cracks and fissures that occur secondary to the disc breaking down. The lack of general disc health and breakdown also makes the disc more susceptible to irritation and injury when we overdo it or are involved in an accident. This can lead more pain and inflammation.
Another issue that occurs with disc degeneration is that as the disc loses height the joint of the spine (facet joints) become compressed. This can lead to the facets becoming a secondary source of pain. A disc herniation or a bulging disc doesn’t have to be present for the disc to be painful. A condition known as internal disc disruption is pain felt from the disc alone and can be a tremendous source of back pain . As cycles of pain begin secondary to a degenerative disc we begin to also lose stability in and around the affected areas.
This can lead to further deterioration and a cycle of degeneration begins. If this process goes undetected or untreated it can lead to advanced arthritis in the spine. As the forces on the facet joints and vertebral bodies becomes excessive they respond by thickening and enlarging, this is the precursor to spinal stenosis.
Treatments for Degenerative Disc Disease
Like most spinal conditions treatments vary from person to person. There are non-surgical and surgical options for degenerative disc disease. Below I will outline a few of the most common and what the treatment goals are.
- Chiropractic Care-The goal with spinal manipulation is to keep the spine moving properly. Manipulation restores motion to the vertebral joints and through this motion the active pumping mechanism that nourishes the disc is optimized. Manipulation also helps to decrease muscle spasms and break up scar tissue in the facet joints. Another benefit is that as joints move they stimulate synovial fluid production and this helps keep the facet joints healthy.
- Exercise– As with any musculoskeletal condition exercise and strengthening can provide great relief and prevention. Keeping the spine flexible and the core muscles strong can help in stabilizing the spine and ensures normal movement occurs throughout the spine and trunk. The benefits of a well thought our rehabilitation program cannot be overemphasized.Inversion table could be ideal for this type of exercise.
- Medications– As with pretty much every medical condition there is a pharmaceutical answer. With pain the drugs do nothing to fix the problem only to mask the symptoms and this is often much needed. Managing the pain can help you do the more active treatments that are going to make a difference in the long run.
- Pain Management– As with medications spinal injections are not healing in nature. They do allow for temporary relief so again you can do more productive treatments and are not limited by pain. In some cases relief may last for long periods of time, however getting into an exercise or rehab program is highly recommended because even though the pain is gone, the degenerative process continues. Pain Management typically consists of things like spinal epidural, facet and SI joint injections when dealing with degenerative disc disease.
- Spinal Surgery– There is a lot of debate as to whether surgery is a viable treatment option for disc degeneration. Most think it has no value when there is no leg pain present. However, if the spine is severely damaged and degenerative a spinal fusion may be recommended and should always be a last resort. The goal with this type of surgery is to fuse the damaged joint with the goal of eliminating the pain.
So as you can see degenerative disc disease can be quite painful and affect your life dramatically. Because it is a chronic condition some form of maintained care is often needed.