Degenerative Disc Disease
Article by John Miller
What is Degenerative Disc Disease?
Degenerative Disc Disease
Your intervertebral discs are the shock-absorbing rings that sit between the bony vertebral bodies in your spine. They are made up of two main parts; the annulus and the nucleus. The nucleus refers to the inner, jelly-like section of the disc which can change shape to adapt to different loads placed on the spine. This is very important for shock absorption between spinal segments, as well as ensuring there is enough room between each vertebra for movement of the spine and for major nerves to pass in and out of the spinal canal.
The annulus is the outer component of the intervertebral disc, and is made up of dense fibrocartilage. This tough layer encases the fluid sac and plays a vital role in controlling the amount of movement the nucleus is allowed.
At birth, your intervertebral discs are made up of up to 80% water. As we age however, the discs “dry out” leading to poorer shock absorption ability and increased risk of small tears developing in the outer annulus layer. This is a normal part of the aging process and, in many cases, is not painful.
This degenerative process affecting your discs is known as degenerative disc disease.
Risk Factors for Degenerative Disc Disease
Although degenerative disc disease is a common part of ageing life, there are some factors which have been linked with higher incidence of disc degeneration. These often relate to increased forces travelling through the spine, and include:
Symptoms of Degenerative Disc Disease
Although degenerative disc disease can pass by unnoticed, an ageing disc can sometimes be very painful. It is thought that this pain originates from the inflammation and/or micro-instability surrounding the affected discs, as well as the muscle spasm that occurs in the area as a natural response to the altered biomechanics of the spine.
The close relationship between your intervertebral discs and the spinal nerves also means that as the disc degenerates and the space between the vertebrae decreases, there is a greater risk of irritation of nerves entering and leaving the spinal canal.
Common symptoms of degenerative disc disease include:
It is important to note that the symptoms and amount of pain experienced varies from person to person, and is not indicative of the amount of degeneration or injury.
Degenerative Disc Disease Diagnosis
Degenerative disc disease or narrowing of the disc space can be identified on MRI scans and X-rays.
However as not all ageing discs are symptomatic. It is important to see your physiotherapist who can ask you questions and perform tests to determine the source of your back pain and treat it accordingly.
Degenerative Disc Disease Treatment
Although your intervertebral discs will continue to age over time, it is highly likely that your back pain will actually decrease and your symptoms are often able to be managed successfully with conservative treatment.
Your physiotherapist will be able to develop an individual program for you to achieve this so you can return to your normal day to day life as quickly as possible.
It is important to note that just because you have degenerative disc disease present on CT scan or MRI, it doesn't mean it will be painful. In fact, when you were pain-free the day before you had your first symptoms, degenerative disc disease would have been present on scans!
Therefore the success in the treatment of degenerative disc disease is managing the disease and your associated findings rather than just the degeneration.
PHASE I - Pain Relief & Protection
Managing your pain is usually the main reason that you seek treatment for degenerative disc disease. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Inflammation is the main short-term reason for why you have suddenly developed degenerative disc symptoms. It best reduced via ice therapy and techniques or exercises that de-load the inflammed structures.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage and temporary use of a back brace.
Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II - Restoring Normal ROM, Strength
As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal joint alignment and range of motion, muscle length and resting tension, muscle strength and endurance.
Your physiotherapist will commence you on a lower abdominal and core stability program to facilitate your important muscles that dynamically control and stabilise your spine.
Researchers have discovered the importance of your back and abdominal core muscle recruitment patterns. A normal order of: deep, then intermediate and finally superficial muscle firing patterns is normally required for pain-free backs. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
Your physiotherapist may recommend a stretching program or a remedial massage to address your tight or shortened muscles. Please ask your physio for their advice.
PHASE III - Restoring Full Function
As your back’s dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic and spine alignment and its range of motion during more stressful body positions and postures. They’ll also work on your outer core and leg muscle power.
Depending on your chosen work, sport or activities of daily living, your physiotherapist will aim to restore your function to safely allow you to return to your desired activities. Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.
PHASE IV - Preventing a Recurrence
Back pain does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal and core muscle exercises. You should continue a version of these exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely.
In addition to your muscle control, your physiotherapist will assess your spine and pelvis biomechanics and correct any defects. It may be as simple as providing you with adjacent muscle exercises or some foot orthotics to address any biomechanical faults in the legs or feet.
General exercise is an important component to successfully preventing a recurrence. Your physiotherapist may recommend pilates, yoga, swimming, walking, hydrotherapy or a gym program to assist you in the long-term.
Fine tuning and maintenance of your back stability and function is best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.
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