Back pain is one of the most common complaints when people pay a visit to their doctor. Lower back pain can be caused by a multitude of problems, but usually it is triggered by overusing the muscles of the back. However, lower back pain can also be caused by sciatica, carrying extra weight due to obesity or pregnancy, a herniated disc or arthritis. However, one of the common causes of lower back pain is degenerative disc disease.
What is Degenerative Disc Disease?
A simple explanation for this disease is that it describes the symptoms of pain and radiating weakness and/or numbness caused by a degenerated disc in the spine. The spine is made up of a chain of bones, called vertebra, that are divided by softer fibrocartilage, spinal discs, that hold the vertebra together and act as a cushion between them. Without the disc separating the vertebra, the bones would grind against each other and quickly wear down. This would not only cause more pain, but people would have difficulty moving around.
Degenerative Disc Disease, often referred to by its initials DDD, technically isn’t a disease. When people get the diagnosis for DDD, they are often worried because it sounds like it could be a disease that will get worse over time. Fortunately, not only is it not a disease, but it isn’t necessarily degenerative either.
While people assume that degenerative symptoms will get worse over time, in the case of DDD, degenerative does not refer to progression of the symptoms, but only the possibility that a disc will degenerate over time. Although disc degeneration can take place as you age, pain from the degeneration usually doesn’t get worse, but it often gets better given enough time.
Disc degeneration is a natural part of the aging process and everyone will show changes or some degeneration in their discs as they get older. Discs contain about 80% water and, as people age, the discs tend to dry out and shrink in size, which can lead to wear and tear on the spine. However, not everyone develops noticeable symptoms of DDD because the condition can vary in how it is presented and in severity.
How Back Pain Lessens with Degenerative Disc Disease
A process called “degenerative cascade” explains how back pain due to DDD can get better over time. Blood contains nutrients and oxygen that it delivers throughout the body to keep organs, muscles and other tissues healthy. However, spinal discs receive a minimal amount of blood, so they have do not have the ability to repair themselves compared to other parts of the body that get more blood.
The reduction of back pain due to DDD is a long process, sometimes taking 20 to 30 years. Studies have shown less back pain in people over 60 years old than those 30 to 50 years of age. Doctor William H. Kirkably-Willis theorized in the 1970s that there are three stages in which a disc degenerates after an injury to it and that can lead to a reduction of pain.
Significant dysfunction caused by the acute back pain due to the injury.
There is a long period of instability in the vertebra where the injury occurred and the patient will have intermittent bouts of back pain.
The body is able to re-stabilize the vertebral segment and the patient experiences less back pain.
What Causes DDD?
Although lifestyle and injuries are what usually leads to DDD, it can also be hereditary. A study that was done in Utah showed that if a parent, sibling or other immediate family member had disc-related lower back pain, such as DDD, then their relatives were four times more likely to also have lower back pain issues. Although researchers admitted the study wasn’t totally conclusive, it did give evidence to a genetic component of DDD.
The most common ways that DDD occurs is:
The loss of fluid in the discs, which occurs naturally with the aging process.
Damage to the disc in which small tears or cracks develop on the outer part of the disc and the fluid from within it leaks out through those cracks or tears. This often results in bulging or ruptured discs.
A sudden injury can accelerate the process of degeneration.
Bone spurs can develop when there is less separation between the vertebra. The spurs can press on the spinal cord and interfere with nerve function and cause pain.
Spinal stenosis, which is the narrowing of the interior of the spinal canal, can also put pressure on the nerve that runs the length of the spine.
There are risk factors for developing DDD. People who are obese have a greater risk of developing DDD. Those who do strenuous physical work and smokers also have a greater chance of developing DDD. Smoking and lower pain back have been linked because smoking causes atherosclerosis, which is the narrowing of the arteries. Studies have also linked Atherosclerosis to lower back pain and degenerative disorders of the spinal discs, including DDD
The Symptoms of Degenerative Disc Disease
The symptoms of DDD often vary between people who develop this disc disorder. Some people may experience little to no pain, while others have excruciating pain that interferes with their daily activities. The early symptoms of DDD often include lower back pain that can be felt in either or both of the buttocks and legs, which is known as sciatica. Sciatica pain is often described by sufferers as a pressure or a burning pain, which can be intense at times.
There are people who also feel a numbness or tingling in their leg or foot, but this usually isn’t a cause for concern unless it is accompanied by weakness in the leg muscles. Sometimes muscle pain can be intense and may last anywhere from a few days to a few months. Many people with DDD experience chronic pain with this condition. For some people, the chronic pain is only annoying, but others can experience intense pain that can be disabling.
Other symptoms of DDD include having worsening pain with some activities like bending down, lifting even a small amount of weight or twisting the body. Being in some positions can increase the pain people feel. Sitting is often worse than standing for those with lumbar degenerative discs because sitting puts up to three times more pressure on the discs in the lumbar region. Walking or running may feel better to some people than sitting or standing for a long period of time.
Changing positions when they sleep can help some people, but also, laying in a recliner with their feet propped up or having a pillow beneath the knees while in bed can feel better because it helps to relieve stress on the lumbar discs.
Cervical and Lumbar Symptoms
Symptoms can vary depending on which area of the spine is affected by disc degeneration. Degeneration in the cervical spine is the most common reason for a stiff neck. Usually DDD in the cervical area is rarer than it is in the lumbar spine, but it can be caused by an injury to the neck, such as a fall or twisting injury. The injury can prompt DDD, as can accumulated wear and tear on cervical discs.
Along with pain in the neck or a stiff neck, disc degeneration can cause numbness, tingling or weakness in the neck, shoulders and arms resulting from irritated or a pinched nerve in the cervical region. Degeneration can cause progressive issues like cervical stenosis, which is a narrowing within the spinal canal, and herniated discs can also occur.
In the lumbar, or lower back area, some of the more common symptoms are:
Lower back pain that can radiate to the hips and legs, which is often caused by inflammation in the disc area.
Continuous back pain that often lasts more than six weeks.
Pain that often feels worse when sitting, standing for long periods of time, twisting motions, bending and lifting objects.
More serve symptoms can be numbing and tingling in the legs. Difficulty walking and developing drop foot can be an indication of nerve root damage.
DDD in the lumbar area can lead to herniated discs or lumbar stenosis.
It should be noted that the patient’s level of pain does not indicate the amount of degeneration in the area. Some patients who experience no or very little pain could have more damage to their disc(s) than a patient who experiences excruciating pain.
Diagnosing Degenerative Disc Disease
If you have persistent back pain, make an appointment with your doctor to get your back problem diagnosed. Your doctor will ask about the location and severity of your pain as well as if you’ve had any recent falls, accidents or injuries. He or she will also ask if there is any numbness or tingling in your back or legs. After you’ve answered your doctor’s questions, he or she will usually conduct an examination in the office.
A nerve function test is often done to check for nerve compression by tapping different areas with a reflex hammer. If there is little to no reaction, it could be because a nerve in your back is compressed. The doctor may also test your nerves with hot and cold stimuli to test their reaction to temperature changes.
The strength of your muscles will be tested by pushing or pulling your legs and feet against the doctor’s hands. They may also have you undress to check for unusual muscle movements, such as twitches, and check for muscle atrophy.
Another way for them to check for possible degenerative disc issues is to examination your back by palpating the area that is sore and having you move in certain ways, like bending over or twisting, to see if the movement causes you pain. If so, it could be a good indication of the existence degenerative disc disease.
After conducting their examination, your doctor may request further diagnostic tests, usually diagnostic imaging tests. A CT, MRI, discogram or myelogram may be ordered so your doctor can see inside of your body and get a look at the spine. They will be able to see any problems with the vertebra, discs and nerves of the spine. They will also check for other possible causes for your symptoms, such as a tumor in or around your spine. Depending on what is found, your doctor may refer you to a specialist like an orthopedist, neurologist or a neurosurgeon.
Treating Degenerative Disc Disease
Unfortunately, disc degeneration cannot be reversed, but with habit changes, exercise and, sometimes, pain management, your back can feel better and your quality of life can improve. However, depending on the severity of your condition, surgery could be necessary to help improve your back’s condition. Surgery is usually a last resort as there is no firm evidence that it can help in cases of disc degeneration.
Nonsurgical Treatments for DDD
Conservative, nonsurgical methods to treat your back are the preferred methods among doctors. Your doctor may suggest habit changes, medications, resting your back, physical therapy and exercise to help reduce pain, inflammation and to help you be more active. Even for severe cases of DDD these suggestions can help improve your condition.
Habit Changes
Making changes to the way you sit, stand and perform routine tasks can help reduce pain in your back and improve your activity level. When you sit, stand or walk, having good posture can help keep your back in alignment, which is the best thing you can do. Prolonged sitting is often painful, so taking a break to stand up or working while standing can help relieve some of the pain you may experience.
When you are sitting watching television, many people feel better when sitting in a recliner with their feet propped up. This helps to reduce the pressure on the lower back, thus reducing pain. Your workstation may need to be adjusted to help you cope with back pain while doing work tasks. Also, learning how to properly bend and lift objects, whether they are light or heavy, can also help your back.
Stress Reduction
Stress can cause your body to feel tense, which acts to increase pain. Reducing your stress by relaxing can help manage your pain and allow your muscles to loosen up, which also reduces pain. Learn to control your stress by deep breathing exercises, mediation and by doing relaxation exercises. If your doctor approves, taking yoga is a good way to reduce stress as well.
Physical Therapy
Going to physical therapy can help patients get back to their normal activities as soon as possible. Exercising can help you heal faster because it works well to reduce the pain associated with DDD. Physical therapists can show you how to strengthen and stretch the muscles in your legs, lower back and stomach, known as your core muscles.
Having strong core muscles helps to support a weak back, which can help improve posture and reduce pain. They will also help you to make your spine more flexible. Some of the exercises to help build your core muscles include yoga, Pilates and swimming. Weightlifting can help strengthen muscles and help your stability, but only do weightlifting exercises that do not bend the body.
Prescription Medications
Taking medications to help reduce pain, inflammation and to keep muscles loose can help those with DDD feel better be more comfortable throughout the day or at night. Some of the medicines you doctor may prescribe are:
Non-Steroidal Anti-Inflammation Drugs (NSAIDS) such as naproxen, ibuprofen or aspirin. They help reduce both inflammation and pain. Your doctor will monitor your liver and kidney function while on these drugs as they can be harmful to those organs when taken for a prolonged amount of time.
Analgesics help with pain relief, but they do not help with inflammation. These drugs don’t have the side effects of NSAIDS and they will often be prescribed in conjunction with NSAIDS, especially if you are coping with severe pain.
Steroids are a fast-acting medication for reducing inflammation and swelling around the nerves. They can be prescribed as an oral medication or as an epidural injection. Steroids will usually help reduce pain within 24-hours.
Muscle relaxants can help keep muscles loose and help stop painful muscle spasms.
Alternative Medicine Treatments
Some people what a more natural way to help treat DDD and some alternative medicines can help reduce stress, pain, muscle tension and help cope with other chronic problems associated with DDD. Chiropractic care, acupuncture, acupressure and biofeedback are some of the treatments that can help treat DDD.
Surgical Options for DDD
If a more conservative approach hasn’t worked or if a patient has more serious problems because of DDD, then your doctor may refer you to a back surgeon to discuss your surgical options. Surgery can remove bone spurs that may be pressing on nerves, decompress nerves and stabilize the areas where there is painful movement of the spine. There are two types of surgery that may be recommended to you:
Spinal Fusion
This surgery stabilizes the spine by joining together two vertebral segments of the spine. This is done by inserting a rod and putting screws in both vertebra to join them together and stop their movement. An interbody fusion cage will also be inserted between the sections of vertebra that are joined together, which will help restore the height of the disc space. Although a spinal fusion can be done on any part of the spine, the cervical and lumbar regions are the most common areas because those sections of the spine have the most movement.
Decompression Surgery
There are different types of decompression surgery that can be done to help relieve pressure on the spine. The types of decompression surgical procedures include:
Facectomy - This removes the facet joint in the section of the spine that is damaged.
Foraminotomy - This involves relieving the compression on the nerve by enlarging the foramen area.
Laminectomy - The surgeon will remove all or part of the lamina in order to relieve the pressure on the spine.
Laminotomy - This surgery is similar to a laminectomy, but the opening is larger in order to give the nerves more room.
Usually the surgeon enters from the back of the spine for these procedures. However, they may have to enter from the front, or anterior, if the patient has a bulging or herniated disc that is pressing up against the spinal canal. Anterior decompress procedures include:
Discectomy - This is done to remove a portion or the entire spinal disc.
Corpectomy - The vertebral bodies and adjacent discs are removed to help relieve pressure on the spinal cord.
Another surgical treatment called Intradiscal Electrothermal Therapy (IDET) can be performed by inserting a thin catheter to insert heat directly into the discs in order to shrink any tears or fissures in annulus and thermo-coagulate nerves to help reduce discogenic back pain.
Although back could be a necessity depending on how the severity of their DDD, if available, your doctor might recommend clinical trials for new techniques or medications to help with DDD instead of resorting to surgery. However, if you are experiencing weakness in the legs, trouble walking or other similar symptoms, surgery may be your best option to stabilize your back and help you be able to maintain or regain an active lifestyle.
If you or anyone else has early symptoms of degenerative disc disease it is important to contact your doctor for an examination. Like any other medical problem, if it is caught in its early stages, treatments can help you strengthen your core muscles and make lifestyle adjustments to help you maintain your activity level and keep the problem from getting worse.
Since degenerative disc disease is part of the natural aging process, it is important to maintain your spine health by exercising on a regular basis, maintaining an appropriate weight, by having good posture and learning how to correctly lift and carry objects. DDD isn’t preventable, but you can maintain your lifestyle with good habits and a healthy spine.
Further reading:
What is Degenerative Disc Disease?
http://www.spine-health.com/conditions/degenerative-disc-disease/what-degenerative-disc-disease
The “Degenerative Cascade” of a Degenerating Disc:
http://www.spine-health.com/conditions/degenerative-disc-disease/degenerative-cascade-a-degenerating-disc
degenerative disc disease (spondylosis):
http://www.mayfieldclinic.com/PE-DDD.htm#.VLxh43sZmFA
Back Pain May Be Inherited:
http://www.webmd.com/back-pain/news/20110204/back-pain-may-be-inherited
What is degenerative disc disease?
http://www.medicalnewstoday.com/articles/266630.php
Additional Resources:
Degenerative Disc Disease Health Center:
http://www.spine-health.com/conditions/degenerative-disc-disease
Degenerative Disc Disease Center:
http://www.spineuniverse.com/conditions/degenerative-disc-disease
Degenerative Disc Disease:
http://www.cedars-sinai.edu/Patients/Health-Conditions/Degenerative-Disc-Disease.aspx