A spinal condition which is commonly seen in our clinic and one which is becoming more prevalent with the aging population is degenerative disc disease. This term seems to be one that people are familiar with as they have heard it either from their medical doctor or other practitioner but commonly aren’t sure what it means exactly or how it may contribute to their lower back pain.
Degenerative disc disease is usually a slow gradual process. People are commonly not aware it is happening until it has progressed to a point where it is causing symptoms. Similar to a cavity in the tooth, the process takes place over months and even years until it becomes severe enough to cause pain. Often the presentation of the patient is almost exactly the same as for simple, non-complicated mechanical back pain. In fact, many patients may feel as though it is exactly the same as previous episodes if they have experienced a history of lower back pain. The first clue that something is different is that it doesn’t respond the same way to treatment as the previous episodes have.
The lack of improvement should be a yellow flag for the practitioner. When a diagnosed condition does not respond as expected to treatment this can be a clinical indication that perhaps an x-ray should be taken. Once the x-ray is taken then the complicating factor of degenerative disc disease is often found.
The nature and characteristics of degenerative disc disease can vary greatly. Commonly, the patient will usually be at least in their mid 40’s but it can occur earlier and certainly later in life. As stated the symptoms may feel very much like common mechanical back pain but typically are described as a dull achy feeling in the lower back sometimes with radiating pain out to the hips and buttocks and sometimes down the back of the legs. DDD may leave patients more vulnerable to acute episodes of lower back pain as the back becomes less able to tolerate stress and strain. It is one of these episodes that generally leads to the eventual finding of DDD.
Specifically, the changes at the disc that occur involve a breaking down of the tissues that make up the disc. The cartilage that makes up the disc begins to change from normal healthy cartilage to a more fibrocartilagenous material. This material is less resilient than the original healthy material and is more prone to tears. The disc becomes thinner and therefore the space between the vertebra becomes thinner in effect compressing the posterior joints of the spine. This compression is one of the factors that leads to pain. With the fibrous changes taking place in the disc there is also an infiltration of nerve tissue that is more prone to inflammation causing more sensitivity. In summary, there are mechanical, chemical and neurological changes associated with DDD that lead to the symptoms that people experience.
Many treatment options are available and surgery is always a last resort. Treatment by physiotherapists, chiropractors and other practitioners that specialize in physical therapies can be very effect. Spinal manipulative therapy can be a very helpful treatment option to relieve pain and increase function in those patients suffering from DDD. In some more difficult cases corticosteroid injection therapy can be helpful as well. There have also been some encouraging results for many using inversion therapy.
Degenerative disc disease is a fairly common cause of lower back pain. It is generally a diagnosis requiring some form of imaging, most commonly x-ray. Many treatment options are available so seek out a chiropractor, physiotherapist or other practitioner that specializes in physical therapies for help. This condition generally responds well to conservative therapy and in only rare cases is surgery required.