Degenerative Disc Disease
What is Degenerative Disc Disease?
The degenerative process affecting your discs is known as 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.
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:
- Carrying excess body weight
- Family history of early disc degeneration
- Careers involving heavy manual labour or vibrations
- Active lifestyle
- Conditions affecting the biomechanics of the spine, such as osteoarthritis and scoliosis
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:
- Lower back pain, which may travel into the buttocks, hips and legs
- Pain that is aggravated by prolonged sitting or activities which load the intervertebral discs such as bending, lifting or twisting
- Relief of pain by changing positions, standing up, lying down, or walking
- Pins and needles or numbness down the leg may also occur when the spinal nerves around the affected disc become sensitive or irritated
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 back pain 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.
Degenerative Disc Disease FAQs
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann's Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)
Back Joint Injuries
Nerve PainNerve pain is pain that is caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the common type of pain that is due to an injury. This is known as nociceptive pain.
What Causes Nerve Pain?Neuropathic pain is caused by a problem with your nerves themselves, which sends pain messages to the brain.
What is Nerve Pain Symptoms?Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.
What Causes Nerve Pain?Various conditions can affect your nerves and cause nerve pain. Common sources of nerve pain include:
- Shingles (post-herpetic neuralgia).
- Trigeminal neuralgia.
- Diabetic neuropathy.
- Phantom limb pain following an amputation.
- Multiple sclerosis.
- HIV infection.
- Other nerve disorders.
Nerve Pain & Nociceptive PainYou can suffer both nerve pain and nociceptive pain simultaneously. Both pain types can be caused by the same condition.
Nerve Pain TreatmentNerve pain is less likely than nociceptive pain to be helped by traditional painkillers such as paracetamol, anti-inflammatories and codeine. However, other types of medicines often work well to ease the pain. Nerve pain is often eased by anti-depressant or anti-epileptic medicines. Please ask your doctor for more advice.
Pain LinksPain & Injury
Tens MachineWhat is a TENS Machine?
Pins and Needles - Paraesthesia
What Causes Pins & Needles?
A moderately pinched nerve is the most common cause of "pins and needles". Pins and needles are referred to as "paraesthesia" in the medical community. Did you know that feeling "pins and needles" can be a worse sign than having pain in your arm or leg? The reason is that you can't even feel pain anymore when you significantly squash the nerve.
Even worse than "pins and needles" is "numbness" or "anaesthesia", which is a total lack of sensation. You will experience anaesthesia when there is severe nerve compression. Anaesthesia or numbness that persists for more than a few hours can be a sign of permanent nerve compression. Please seek prompt medical attention to prevent the nerve from permanent damage and the muscles it innervates to weaken drastically.
The majority of pinched nerves and nerve compressions are only transient and quickly reversed with early treatment. However, neglect can lead to permanent nerve compression injuries, which may never recover.
Common Causes of Pinched Nerves
The most common forms of nerve compression are in the spinal joints where either a disc bulge or a bony arthritic spur can irritate and compress the nerve. Compressions can also occur as the nerve passes through or around muscles. Your physiotherapist will know where to look.
How Can You Fix "Pins and Needles"?
If you know of someone who is experiencing chronic or permanent "pins and needles", "numbness" or "muscle weakness", please encourage them to seek urgent professional advice. The secret to quick success is the correct diagnosis. A highly trained health practitioner such as your physiotherapist or doctor is your best port of call.
Youth Spinal Pain
Teenager Neck & Back PainTeenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control. The competitive athlete and most individuals who exercise regularly or maintain a level of fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Your physiotherapist can assist the resolution of any deficits in this area. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports.Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these type of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
PelvisCommon Youth & Teenager Sports InjuriesCommon Youth Leg InjuriesCommon Youth Arm Injuries
Back Muscle StrainsBack muscle injuries are the most common form of back injury. Muscle fatigue, excessive loads or poor lifting postures are the most common problems. Inefficient back muscles can lead to poor joint stabilisation and subsequent injury.More info: Back Muscle Pain
Ligament SprainsLigaments are the strong fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling and pain. Awkward lifting, sports injuries, and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.More info: Back Ligament Sprains
Bulging DiscsA bulging disc injury is a common spine injury sustained to your spine's intervertebral disc. Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs.The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as a slipped disc), can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs.More info: Bulging Discs
Bone InjuriesYou can also fracture your spine if the force involved is highly traumatic or you have a low bone density (e.g. osteoporosis).More info: Osteoporosis
Poor PosturePoor posture when sitting, standing or lifting at work can place unnecessary stress on your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure.More info: Poor Posture
What Can Cause Severe Low Back Pain?A sudden injury most often causes acute low back pain. The most common injury sources are the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. But occasionally, it can have a more sinister cause.
Warning Signs of a More Serious Back Injury?In these instances of neurological deficit, please urgently consult your nearest hospital, doctor or physiotherapist. The following neurological signs warrant prompt assessment:
- pins and needles (paraesthesia),
- numbness (anaesthesia),
- leg muscle weakness,
- altered reflexes,
- difficulty walking,
- loss of control of bladder or bowels.
Non-Musculoskeletal Causes of Low Back PainAlthough most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.
What Causes Lower Back Pain?Researchers and spinal health care practitioners categorise lower back bain into the following categories:1. Specific Spinal Pathologies (<1%)2. Radicular Syndromes (5-10%)
- Radicular pain, e.g. sciatica
- Spinal Stenosis
Specific Spinal PathologiesSome conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include:
- spinal infections
- cancer (malignancy)
- spinal arthropathies (e.g. rheumatoid arthritis or ankylosing spondylitis)
- cauda equina syndrome
- spinal fractures.
Radicular SyndromesLower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of the presentations of back pain to general practitioners.
Radicular pain (e.g. sciatica)The most common pinched nerve in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury, you can modify any spinal nerve function (e.g. femoral nerve).The following back injuries may cause radicular pain:
- Herniated disc (slipped disc)
- Facet joint sprain
- Degenerative disc disease
- Back ligament sprain.
RadiculopathyLumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or eversion muscle weakness that can affect your ability to walk.
Spinal StenosisSpinal stenosis is a slightly different condition and relates to the narrowing of the spinal canal. Spinal stenosis is usually more prevalent as you age.
Non-Specific Lower Back Pain (NSLBP)Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify sufferers of lower back pain with no specific structure injured. It is a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms.Fortunately, these conditions account for approximately 90-95% of lower back pain and can nearly always successfully rehabilitate without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.
NSLBP CausesThe causes of NSLBP are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries.Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (e.g. poor posture) are probably more common but also more straightforward to prevent. In these cases, positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period to cause injury and back pain.Most commonly, NSLBP causes include back muscle strain or back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly your acute disc health and predispose you to the severe pain.The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.
What is Back Muscle Pain?Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common. Back muscle pain is the most common source of back pain. The good news is that it is also one of the quickest to heal and rehabilitate.
What Causes Back Muscle Pain?Most causes of low back pain are muscle, ligament or joint-related. Commonly, these muscular strains, ligament sprains and joint dysfunction arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes.The causes of pure back pain are numerous but roughly fall into the following categories.
Back Muscle StrainsMuscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems.Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to reduced joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor PosturePoor posture, when sitting, standing and lifting at work, can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch, and this puts spinal joint muscles and nerves under pain-causing pressure or strain, that results in back pain.
Ligament SprainsLigaments are the durable, fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain.Awkward lifting, sports injuries and motor vehicle accidents are prevalent causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
What are the Symptoms of Back Muscle Pain?Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain.Typical back muscle pain symptoms include:
- Localised back pain, with no radiation into your buttock or leg.
- Back muscle tenderness and spasm.
- Protective back stiffness.
- Sudden back pain onset.
How is Back Muscle Pain Diagnosed?Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn't significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains are similar. Most spinal practitioners refer to both injuries as a category called a "Back Strain" or "Musculoligamentous Strain".X-rays and CT scans do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to determine the muscle or ligament structures injured.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!A spinal healthcare practitioner, such as your physiotherapist, should thoroughly; examine you to exclude more severe sources of back pain.Numerous injuries can cause back pain, and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment aims to protect your damaged tissue while hastening your muscle and ligament healing and then look at strategies to prevent a recurrence.Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
Back Strain CausesWe do know that some people are vulnerable to repeated lower back sprains and strains. While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth!The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but are right next to the joint to control excessive slides and glides. When they don't work correctly, the joint can slide too far and strain its supporting ligaments. Ouch! That hurts.The good news is poor core stability can be easily corrected to prevent back pain. Please contact your physio for more information or to have your core activation accurately assessed.High-risk factors of back pain include:
- sudden forceful movement
- lifting a heavy object
- twisting the back
- coughing or sneezing
- prolonged sitting with poor posture