For some people, living with chronic pain due to degenerative disc disease/DDD has become a way of life. While there is no way to totally correct degenerative disc disease, for the vast majority of people suffering low back pain, sciatica, neck pain, or arm pain and tingling due to this condition, they can successfully manage their pain and regain their lives – while avoiding surgery.
What is Degenerative Disc Disease?
People diagnosed with degenerative disc disease wonder what this means for them and how it will impact their health in the future. It describes the pain and possibly radiating weakness or numbness that can occur due to the degenerated disc in the spine.
The diagnosis sounds like a progressive, threatening disease but it is not a disease and it is not strictly degenerative. It is the term used to describe the normal changes in your spinal discs as you get older. Discs are soft, compressible shock absorbers separating the vertebrae of your spine that allow you to flex, bend, and twist.
Degeneration of the spinal discs may lead to or speed up the onset of other conditions, including:
- Osteoarthritis
- Bulging, protruding, or herniation of a spinal disc
- Spinal stenosis - a narrowing of the spinal canal
- Spondylolisthesis - a slipping of one vertebral body (bone of the spine) forward on another vertebra
These may put pressure on the spinal cord and nerves, leading to pain and may affect nerve function.
The pain from DDD is believed to come from two sources:
- Inflammation - proteins within the disc space may cause a lot of inflammation, causing pain
- Abnormal micromotion instability - as the outer rings of the discs degenerate and wear down, they are not as effective in resisting motion of the spine.
Inflammation and micromotion instability can cause spasms and it is believed this causes flare-ups of intense pain that is often associated with DDD.
Common Symptoms of DDD
- Pain related to activity that flares-up and then returns to a low-grade level or goes away.
- Severe episodes of pain that may last for a few days to months before returning to a baseline level.
- The amount of chronic pain (the person's baseline level) can range from a nagging pain to severe and disabling.
- Certain activities often worsen the pain, especially bending, lifting, and twisting. Some positions will usually make the pain worse. As an example, DDD of the lower back is often worse with sitting as the load on the discs is three times more when sitting compared to standing. Walking, and even running may feel better than long periods of sitting or standing. People will often feel better if they can change positions frequently or any position that relieves stress on the lumbar disc, such as lying in a reclining position (such as in a recliner with the legs propped) or lying with a pillow under the knees.
While it may seem counter-intuitive, severely degenerated discs may produce little to no pain and discs with little degenerative change may cause severe pain. Therefore, it is important to understand that if you are experiencing severe pain, it doesn't mean something serious is wrong with your spine and it does not mean you need surgery to repair any damage.
Treatment & Management of DDD
In the vast majority of cases treatment is nonsurgical and may include one or a combination of many medical, alternative, and/or self-help methods. It is often necessary to take a trial and error approach to determine what works best for you.
How far to progress with the treatments will depend upon the severity of your condition, how frequent your flare-ups occur, and how much it is affecting your ability to function and enjoy life. If you are unable to golf, play with your grandkids, etc., the treatment program would be more involved than if you just had some mild soreness and stiffness.
The rest of this article will briefly describe some of the possible treatments and lifestyle changes to consider. Pain reduction that allows you to perform rehabilitative exercises is essential in any long-term program to manage DDD. As the pain is cause by both instability and inflammation, both of these must be addressed.
1. Lifestyle Modifications
- Use proper ergonomics and posture to avoid stress on the spine.
- Proper lifting technique is very important.
- Avoid nicotine and excess alcohol.
- Move frequently. As an example, stand and stretch each 10-30 minutes instead of sitting for long periods.
- Drink plenty of water. Most people are not medically dehydrated but are physiologically dehydrated. Sufficient water is essential for the body to function properly.
- Weight loss can be very beneficial if you are overweight. Even a small decrease can greatly reduce the stress on the discs and joints. Don't believe me? Put 10 pounds in a backpack and carry it around for an hour and you will find how much extra stress that places on your body.
- When indicated, modifying your environment can be very helpful. An example would be changing the height of a bench or table you work on frequently.
2. Rehabilitative Exercise
- A properly designed exercise program is essential to managing DDD and it should be performed daily.
- The types and amount of exercises will vary upon your current condition and abilities.
- Your program should include aerobic, stretching, and strengthening exercises. Work with your doctor to establish a plan that is right for you.
- The goals of exercise are to help heal the back and to prevent or reduce recurrences.
- Another benefit is exercise helps reduce pain naturally by releasing the body's natural pain reliever - endorphins.
Examples of some of the exercises that may be recommended may be found on this website under the PATIENT RESOURCES - EXERCISE VIDEO tabs. Check with Dr. Wray to make sure it is safe for you to perform any of these before starting an exercise program.
3. Chiropractic Spinal Adjustments
- Spinal adjustments help restore normal joint motion and function, taking pressure off sensitive neurological tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and releases endorphins which are natural pain relievers.
- There are many chiropractic adjusting techniques and the method of adjusting will vary according to your specific needs and current condition. I am proud to be able to offer my patients the computerized - PRO ADJUSTER - for gentle yet very effective adjustments.
4. Spinal Decompression Therapy
- Non-surgical spinal decompression is a non-invasive treatment for patients who suffer from neck and back problems. A decompression treatment slowly and gently lengthens or releases pressure in the spine through repetitive movements by a customized treatment table.
- The table pulls and releases, creating a pressure change in the intervertebral disc, surrounding soft tissue, and joints. This pressure change allows the disc bulges or herniations to be pulled back into the disc; i.e. decompression reduces intradiscal pressure.
- Rehydration of the disc and surrounding structures creates a physiological change which assists the body's natural healing process.
5. Medication
- Typical medications used to treat DDD include NSAIDS, acetaminophen (Tylenol), oral steroids, narcotic drugs, and muscle relaxers.
- While these can be somewhat effective in many cases, long-term use may cause side-effects, many of which are serious, including death. Therefore, it is important to weight the benefits and risks when using any of these medications, especially if taken for extended periods of time. Doesn't it make sense to start with safer, more conservative treatments when possible?
6. Epidural injections
- These are reserved for severe cases that are not responsive to other conservative measures.
7. TENS
- TENS is a form of electrical stimulation that blocks the pain signal to the brain and may be useful in some cases of chronic pain.
8. Massage
- Therapeutic massage may help by improving blood flow, reducing muscle tightness, increasing range of motion, and raising endorphins.
9. Nutritional Supplementation
- There are many supplements and lotions that may help with the pain and inflammation. What works for one person may not work for another person. A trial and error method is often needed to determine what works best for you.
- Some of the products are turmeric (Curaphen is an excellent source), white willow bark, digestive enzymes, Boswellia, DLPA, glucosamine sulfate, and O-mega 3, as well as many others.
10. Anti-inflammatory Diet
- Certain foods promote inflammation which others are anti-inflammatory. The Standard American Diet/SAD is very pro-inflammatory and promotes chronic pain. For more information, ask for our Anti-Inflammatory Diet handout.
11. Surgery
- Surgery should only be used as a last resort in the more severe cases where all other treatment measures have been unsuccessful and there is marked interference with normal living.
The information contained in this article is not meant to diagnose, treat or claim to cure any condition.
It is for educational purposes only. Please discuss any questions you may have with your doctor.