Are you aware that as much as 85% of the global populace will grapple with lower back pain at some point in their lives (1)? Interestingly, this type of discomfort stands as the second most common reason people consult their doctors.
A substantial proportion of this back discomfort is connected to the degenerative alterations that occur in the spinal discs. Most people have some level of disc deterioration, or what is medically referred to as Degenerative Disc Disease (DDD). DDD represents a form of osteoarthritis that specifically affects the spine.
Article Index
Introduction
Degenerative Disc Disease can manifest anywhere in the spine, but it typically presents itself in the neck (cervical region) and the lower back (lumbar region).
Under normal circumstances, healthy discs function as shock absorbers. However, when these spinal discs begin to deteriorate, there's an immediate decrease in their ability to absorb shock.
This reduced functionality can lead to various serious outcomes, including:
Degeneration of the facet joints, also known as osteoarthritis.
Spinal discomfort, rigidity, and impairment.
Formation of bone spurs.
Deterioration of the vertebral body (end plates), which in turn increases pressure on the spinal nerve roots - these are the nerves that extend from the spinal cord. Over time, this can result in pain radiating down the arms or legs, similar to sciatica.
A Closer Look at Your Intervertebral Discs
Let's pause for a moment to appreciate the crucial function your intervertebral discs perform in your routine movements and tasks.
Intervertebral discs, which are fibro-cartilaginous cushions, constitute about one-quarter of the spinal column's length and serve as the spine's shock absorption mechanism.
These discs are engineered to:
It can withstand immense amounts of stress, function like a hinge, and enable an increased range of motion and flexibility in the spine. It also safeguards the spinal cord and its nerve roots.
These discs are situated between the vertebrae of the spine and are connected to them. They form a segment of the front wall of the spinal canal.
The structure of the discs is primarily composed of two layers:
Annulus Fibrosus
This constitutes the outer rim of the disc and is a robust spherical formation made of collagen fiber sheets that are connected to the end plates of the vertebrae (the ends of the vertebral bodies).
Nucleus Pulposus
This component forms the core of the disc and is a jelly-like substance capable of withstanding significant compressive forces.
Given that these intervertebral discs LACK a direct blood supply, they rely on the end plates of the vertebral bodies for nutrient circulation. Any issues resulting in a decrease in the regular fluid exchange within this region can lead to many degenerative conditions.
What Is Degenerative Disc Disease?
When it comes to disc degeneration, it's intriguing to point out that the changes happening to spinal discs during the typical aging process are not the same as those in Degenerative Disc Disease (DDD). Surprisingly, normal aging and DDD are distinct biological phenomena!
To shed more light on this, let's delve into some of the key disparities between the natural aging process and DDD, particularly concerning the intervertebral discs in the lumbar spine.
This fresh insight is courtesy of RRS education (Dr. Shawn Thistle), the organization's founder. Dr. Thistle conducts seminars that encompass the most recent research across a broad spectrum of musculoskeletal subjects. I wholeheartedly endorse participating in one of his insightful seminars if you're a practitioner.
Characteristic signs of normal aging of the intervertebral discs:
There is NO reduction in the height of the intervertebral disc.
The water content within the vertebral disc decreases, resulting in significant dehydration by the age of 40.
The orientation of the fibers within the disc becomes irregular, and fissures start to form.
The aging process unfolds from the inside out, meaning the core of the disc starts to age before the outer layers.
In contrast, Degenerative Disc Disease involves a different set of changes and effects, which can lead to pain, discomfort, and limited mobility. Understanding these differences is crucial for healthcare practitioners in diagnosing and treating spinal conditions.
Key indicators of Degenerative Disc Disease (DDD) in the intervertebral discs encompass:
A substantial reduction in intervertebral disc height impairs the disc's shock-absorbing ability.
Pathological alterations in the vertebral endplates. The presence of these changes is a definitive sign that DDD is in play.
Contrary to normal aging, DDD initiates changes from the outside, moving inward.
Discs become highly rigid and weakened, with a compromised capacity to bear loads.
Fissures and tears begin on the external part of the disc (Annulus Fibrosus) and progress inward, fostering the growth of nerves and blood vessels. This inward growth creates pain generators.
When subjected to load, DDD-affected discs lose fluid faster than aging discs. As a result, they experience a reduction in disc height and a diminished ability to withstand loads.
In essence, DDD is a more severe and accelerated form of disc degeneration compared to normal aging, leading to notable structural changes and often causing significant pain and functional limitations.
Note:
The prevalence of Cervical Disc Degeneration is high. According to a 2015 study by Nakashima and colleagues, 1211 healthy volunteers ranging in age from 20 to 70 were evaluated for cervical disc degeneration using MRI. The findings revealed that a striking 90% of the participants had disc bulging. Intriguingly, even amongst those in their 20s, 75% exhibited disc bulges. The notion that individuals as young as in their 20s could have vertebral disc damage is often overlooked, even though this study clearly demonstrates its possibility.
Diagnosis of DDD
The following video demonstrations cover typical orthopedic and neurological examination tests that we administer to patients suspected of having Degenerative Disc Disease. These tests are crucial for assessing the physical and neurological aspects of the patient's condition. They provide insights into the structure and function of the spine, the nervous system's health, and potential vascular issues that could be contributing to the patient's symptoms. Please note that these tests are performed in conjunction with diagnostic imaging as needed, which further aids in a comprehensive and accurate diagnosis.
Efficient Orthopedic Testing
This video delves into some typical causes of lower back pain and illustrates how to diagnose them using orthopedic examination techniques. Orthopedic testing is pivotal in the diagnostic process as it helps rule out other potential conditions that might present similar symptoms. By accurately identifying the source of the pain, we can ensure that the patient receives the most suitable treatment for their specific condition.
Lower Limb Neurological Examination
Examination of Lower Limb Neurology
The neurological examination of the lower limb is integral to the complete neurological evaluation. It serves to evaluate the motor and sensory neurons responsible for the function of the lower limbs. This assessment is crucial in identifying any deficiencies in the nervous system. Neurological testing becomes especially important in the context of Degenerative Disc Disease (DDD). DDD can lead to nerve compression, causing pain, numbness, or weakness in the lower limbs. Using this examination as a screening and investigative tool, we can detect nerve-related issues early, better understand the extent of the nerve involvement, and tailor treatment plans accordingly.
Peripheral Vascular Examination
A peripheral vascular examination is an essential diagnostic tool employed to discern any indications of vascular-related issues. This examination becomes particularly important when dealing with Degenerative Disc Disease (DDD). While DDD primarily affects the spine, it can indirectly impact the vascular system by causing inflammation or structural changes that impinge upon blood vessels, which can lead to circulatory issues. Early detection and treatment of Peripheral Vascular Disease (PVD) can help prevent cardiovascular and cerebrovascular complications. This video outlines some of the common procedures we execute in everyday clinical practice to assess vascular health.
Managing Degenerative Disc Disease
A significant number of our patients are often unaware that non-surgical options exist for treating Degenerative Disc Disease (DDD).
Indeed, it's important to understand that while we can't reverse time and completely undo the disc degeneration, a substantial amount can be achieved to manage the condition and improve quality of life.
By utilizing a combination of manual therapy and exercise, we can make a notable difference in the majority of cases. This approach can enhance patients' quality of life and significantly reduce the discomfort they're experiencing due to DDD.
In our treatment plan for DDD, we focus on three primary goals:
Enhancing joint mobility: By improving the range of motion in the affected areas, patients can experience decreased discomfort and increased overall functionality.
Alleviating pain and stiffness: Through targeted therapies and exercises, we aim to reduce the chronic pain and stiffness often associated with DDD, contributing to a better quality of life.
Slowing down further joint damage: While we can't stop the degenerative process entirely, our methods can help slow down the disease's progression, helping preserve joint health for as long as possible.
Interestingly, current research indicates that a combination of manual therapy and exercise can be as effective as surgery (specifically, surgical spinal fusion) in the long term. This approach can reduce pain and disability for patients suffering from DDD, offering a non-invasive alternative with comparable outcomes (2). Thus, patients have more choices when it comes to managing their condition, which can be tailored to their personal needs and preferences.
Manual Therapy: A Highly Effective Approach
When treating Degenerative Disc Disease (DDD) with manual therapy, two crucial factors must be considered to achieve the best outcomes: joint mobility and tissue quality.
Joint Mobility: In cases of DDD, the affected joints often lose their normal range of motion, leading to stiffness and discomfort. Manual therapy, which includes various hands-on techniques, can help restore this mobility. By carefully manipulating the affected areas, we can improve joint flexibility and movement, thereby reducing pain and enhancing function.
Tissue Quality: DDD can negatively impact the quality of the surrounding tissues, including muscles, ligaments, and tendons. Through targeted massage and manipulation, manual therapy can help improve tissue health and resilience. It can promote better blood circulation, reduce muscle tension, and facilitate healing.
The beauty of manual therapy lies in its personalized and non-invasive nature. It focuses on the body's innate healing abilities, enhancing them through professional guidance. For DDD patients, this means a treatment approach that doesn't just manage the symptoms but also contributes to overall spinal health, potentially slowing down the progression of the disease.
Chiropractic Adjustments
Chiropractic adjustments serve as powerful tools in managing Degenerative Disc Disease (DDD). When patients with chronic back pain due to DDD receive chiropractic care at regular, pre-planned intervals, known as Chiropractic Maintenance Care, they typically experience significant improvements. This method is especially beneficial compared to only seeking care during acute back pain episodes.
Chiropractic adjustments aim to restore the normal function and movement of the spine, which can become compromised due to DDD. Moreover, chiropractic care adopts a holistic approach, considering the body as a kinetic chain where all parts are interconnected. In the context of DDD, this means that not only the affected discs are considered, but also how the condition impacts the overall spinal function and the balance of the entire musculoskeletal system.
Neck Adjustments or Neck Mobilization - Tailoring to Your Needs!
When it comes to dealing with Degenerative Disc Disease (DDD) affecting the neck, patients often don't realize that they have options in how joint restrictions in their necks are managed. Whether it's neck adjustments or neck mobilization techniques, the choice truly is yours!
Neck adjustments involve the manual manipulation of the cervical spine to restore mobility and alleviate pain. On the other hand, neck mobilization is a gentler method that uses slower, more controlled movements to improve neck flexibility.
In the context of DDD, both techniques can effectively mitigate the symptoms and enhance neck function. The best approach depends on the individual patient's condition, comfort level, and preference.
In the above video, Dr. Abelson provides examples of Cervical Joint Mobilization. This demonstration will help you understand the procedure and its potential benefits in treating DDD of the cervical spine. Ultimately, the goal is to offer you personalized care that best addresses your unique needs and promotes your overall spinal health.
Soft Tissue Mobilization
When in optimal balance, the myofascial system effectively distributes force throughout the body and facilitates the storage and release of energy for normal motion. In the context of Degenerative Disc Disease (DDD), this system can be likened to a secondary shock absorption mechanism for the spinal column, reducing harm and maintaining stability.
However, issues such as muscle imbalances can arise when this system becomes compromised due to DDD. Tissues surrounding the spinal column may start to thicken, and this system's stability can be jeopardized. This can exacerbate the discomfort and functional limitations associated with DDD.
Fortunately, specific techniques, such as soft tissue mobilization, have been designed to address these myofascial challenges. By applying targeted pressure and movement to the muscles, ligaments, and tendons, soft tissue mobilization can help restore balance, improve tissue health, and enhance spinal stability.
MSR - Low Back Release Protocol
Dr. Abelson demonstrates an effective low back release protocol in the video that is being presented.
Exercise: A Critical Component
Incorporating exercise into your daily routine is essential for successfully addressing back pain caused by Degenerative Disc Disease (DDD). However, it's crucial to understand that exercise programs must be tailored to the individual's specific needs and abilities to achieve the best results.
When it comes to managing DDD, exercise plays a critical role in improving mobility, enhancing strength, and maintaining balance. By working on these key aspects, patients can alleviate pain, promote spinal stability, and slow down the progression of the disease.
The following examples showcase exercises we might prescribe to our patients suffering from DDD. These exercises should be customized to suit each person's unique condition and fitness level, ensuring a safe and effective path to better spinal health.
Two-Minute Cat-Cow Exercise
We recommend patients perform the Cat Cow exercise immediately when they wake up, even before they get out of bed every morning. Most patients never adequately perform enough repetitions of this exercise to receive all its benefits. That is why we have designed this incredibly effective two-minute Cat-Cow Protocol.
5 Minute Low Back Pain Relief
Have a sore lowe back from sitting too long in front of your computer? Try our "5-Minute Low Back Pain Relief" routine. Doing this routine several times per day can make a huge difference in your back pain.
6 Minute Plank Routine
Intermediate: A weak core can lead to poor posture, lower back pain, hip and knee injuries, and more. Working on core strength is a great place to start if you want to improve your athletic performance.
Conclusion - Degenerative Disc Disease (DDD)
In summary, Degenerative Disc Disease (DDD) significantly impacts life quality but can be effectively managed with non-surgical treatments. These include manual therapies, chiropractic adjustments, soft tissue mobilization, and a personalized exercise regime focusing on mobility, strength, and balance.
Accurate diagnosis through orthopedic, neurological, and vascular evaluations is key to effective DDD management. Understanding these methods helps patients make informed treatment choices.
Contrary to common beliefs, DDD doesn't necessitate a life of inactivity and discomfort. Proper management enables individuals to maintain an active lifestyle and high quality of life, demonstrating that a DDD diagnosis doesn't define one's ability to lead a fulfilling life.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective, patient-centred personalized care.
As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.
References
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Jacobs, W., Van der Gaag, N. A., Tuschel, A., de Kleuver, M., Peul, W., Verbout, A. J., & Oner, F. C. (2013). Total disc replacement for chronic back pain in the presence of disc degeneration. Cochrane Database of Systematic Reviews, (9).
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