Did you know that up to 85% of the population will experience low back pain throughout their lifetime (1). In fact, back pain is the second-leading reason that patients seek out the help of their medical practitioner.
A large percentage of this back pain is associated with the degenerative changes that take place in the spinal discs. The majority of the population has some degree of disc degeneration or Degenerative Disc Disease (DDD). DDD is a type of osteoarthritis of the spine.
Degenerative Disc Disease can occur at any location in the spine but is most common in the neck (cervical region) and the low back (lumbar region).
Healthy discs normally act as shock absorbers. Once the spinal discs start to degenerate there will be an immediate reduction in the discs shock absorption capacity.
This decreased capacity can have several severe consequences, such as:
Facet joint degeneration (osteoarthritis).
Spinal pain, stiffness, and dysfunction.
Bone spur formation.
Degeneration of the vertebral body (end plates), which intern causes increased pressure on the spinal nerve roots (nerves that exit from the spinal cord). This can eventually cause radiating pain down the arms or legs (sciatica type pain).
More About Your Intervertebral Discs
It’s worth taking a minute to understand the important role that your intervertebral discs play in your daily motions and activities.
The intervertebral discs (fibro-cartilaginous cushions) make up to one-quarter of the spinal column's length, and function as the spine's shock absorption system. Intervertebral discs are designed to:
Absorb a huge amount of stress.
Act as a hinge, permitting increased range of motion and mobility in the spine.
Protect the spinal cord and its nerve roots.
The discs lie between, and are attached to, the vertebrae of the backbone. They form part of the front wall of the spinal canal.
The discs are made up of two primary layers:
Annulus Fibrosus – This forms the outer edge of the disc and is a strong spherical structure made up of sheets of collagen fibres that are connected to the vertebral end plates (end of the vertebral bodies).
Nucleus Pulposus – Which forms the centre of the disc and is a gel-like material that is able to resist great compressive forces.
Since these intervertebral discs DO NOT have a direct blood supply, they are dependent on the end-plates of the vertebral bodies to circulate essential nutrients. Any problems that cause a decrease in the normal exchange of fluids within this area can lead to a host of degenerative conditions.
WHAT IS DEGENERATIVE DISC DISEASE?
Disc degeneration: It is very interesting to note that what occurs during normal aging to spinal discs is not that same as degenerative disc disease (DDD). Normal aging and DDD are different biological events!
Let's review some of the major differences between normal aging and DDD in relationship to the intervertebral discs of the lumbar spine.
This recent information comes from RRS education (Dr. Shawn Thistle), Dr. Thistle, the founder of RRS education, teaches seminars covering the latest research on a wide variety of musculoskeletal topics. I highly recommend you attend one of his seminars if you are a practitioner.
The hallmarks of normal aging of the intervertebral discs include:
NO decrease in the intervertebral disc height.
A decrease in the water content in the vertebral disc, in facet there is considerable dehydration by age 40.
Fiber orientation of the disc that becomes irregular, with the formation of fissures.
An aging process that occurs from the inside out.
The hallmarks of the degenerative disc disease in the intervertebral discs include:
A considerable decrease in the intervertebral disc height, which decreased the disc's ability to absorb shock.
Pathological changes in the vertebral endplates. When these endplate changes are observed it is a definitive indication that DDD is present.
Changes from the outside in, not from the outside in out as with normal aging.
Discs that become very stiff/weakened, and have an impaired load bearing capacity.
Fissures and tears occur on the outside of the disc (Annulus Fibrous) moving inward, this enables in growth of nerves and blood vessels. This ingrowth creates generators of pain.
Discs that when loaded lose fluid quicker than aging discs, consequently they lose disc height, and have a decreased ability to bear loads.
Note: Cervical Disc Degeneration is common. In the 2015 study (Nakashima et al 2015) 1211 healthy volunteers between the ages of 20 to 70 were examined by MRI for cervical disc degeneration. The results showed that 90% of those examined had bulging discs. What was interesting was that 75% of those in their 20's also had disc bulges. Most people never consider that someone in there 20's could have damage to their vertebral discs.
The following videos are common orthopaedic and neurological examination tests that we perform on our patients with Degenerative Disc Disease. This would be in addition to diagnostic imaging if required.
Low Back Examination
Effective Orthopaedic Testing - This video covers some of the common causes of low back pain and how to diagnose them using orthopaedic examination procedures. (Note: This video is available for the general public on November 7/2022)
Lower Limb Neuro Examination
The lower limb neurological examination is part of the over all neurological examination process, and is used to assess the motor and sensory neurons which supply the lower limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool. (Note: This video is available for the general public on November 11/2022)
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is a valuable tool used for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video we go over some of the common procedures we perform in daily clinical practice. This video is available for the public on November 14/2022.
MANAGEMENT OF DEGENERATIVE DISC DISEASE
Many of our patients do not realize that they have non-surgical options for treating Degenerative Disc Disease (DDD).
Though it is true that no one can turn back the clock and completely reverse the degeneration, there is still a considerable amount that can be done.
A combination of manual therapy and exercise can - in the majority of cases improve the patient's quality of life while alleviating the suffering they are experiencing.
There are three primary objectives that we try to address when treating DDD:
Improvement of joint mobility.
Reduction of pain and stiffness.
Inhibition of the progression of further joint damage.
Interestingly, research is showing that (over the long term) a combination of manual therapy and exercise is just as effective as surgery (surgical spinal fusion) at reducing pain and disability for patients who suffer from DDD (2).
MANUAL THERAPY CAN BE VERY EFFECTIVE
There are two aspects of treating DDD with manual therapy that must be addressed to achieve optimal results. The first is addressing joint mobility and the second is tissue quality.
Research has shown us that when joints become immobile, due to injury or osteoarthritis, they then become subject to several physiological changes such as:
Decreases in fluid content, which causes a decrease in the joint-fiber distance within the capsule surrounding the joint.
Increased adhesion formation in the synovial folds of the joints. Which can cascade into tissue failure, even with diminished tissue loading. (1, 2)
Fortunately, research has shown that joint mobilization can increase mobility, by breaking adhesions within the joint capsule.
The Power of Chiropractic Adjustments
Chiropractic Adjustment are powerful tools. When patients who suffer from chronic back pain receive care, at regularly pre-planned intervals, (Chiropractic Maintenance Care), then they do much better as compared to patients who only receive care during episodes of acute back pain.
Neck Adjustments or Neck Mobilization - The Choice Is Yours! Neck Adjustments or Neck Mobilization Techniques, the choice is yours! Most patients do not realize that they have choices in how restrictions in the joints of their necks are addressed. In this video Dr. Abelson shows you examples of Cervical Joint Mobilization.
MYOFASCIAL RELEASE & JOINT MOBILIZATION
When our myofascial system is in good balance, it distributes force throughout the body, and allows us to store and release energy for normal motion. Think of this system (when functioning correctly) as your spinal columns secondary shock absorption harm reduction system.
The problem is that when it becomes compromised muscle imbalances form, tissues that surround the spinal column start to thicken and the spinal stability it produced is compromised. Fortunately, there are techniques specifically designed to address these myofascial problems.
Here are some examples of procedures that our patients have found beneficial in addressing DDD. Please note: these videos are for demonstration purposes only and should only be performed by a qualified practitioner.
Thoracolumbar Fascial Release - Motion Specific Release: The thoracolumbar fascia (TLF) plays a critical role in both stabilization of the spine and in load transfer from the core. In this video Dr. Brian Abelson DC. demonstrates an extremely effective way of releasing the TFL. MSR videos are for demonstration purposes only. If you have a medical condition, please see your medical practitioner.
The Gluteus Maximus Release - Motion Specific Release (MSR): In this video Dr. Abelson demonstrates how to use Motion Specific Release (MSR) to release restrictions in the Gluteus Maximus muscle. Strong, flexible, engaged gluteal muscles are critical to optimum performance and injury prevention. MSR videos are for demonstration purposes only. If you have a medical condition, please see your medical practitioner.
Exercise is not optional, if you want to successfully address back pain you must exercise on a daily bases. What is also incredibly important is that exercise programs must be tailored to the needs of the individual. The follow are example of exercises we may prescribe to our patients suffering from DDD.
Two Minute Cat-Cow Exercise
We recommend patients perform the Cat Cow exercise immediately when they wakeup, even before they get our 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 low 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 Having a weak core makes you susceptible to poor posture, lower back pain, hip and knee injuries and more. If you want to improve your athletic performance working on your core strength is a great place to start.
Don't become discouraged if you find that you are suffering from degenerative joint disease. The reality is that most people over a certain age have DDD . Fortunately there are specific strategies you can use to decrease your pain, increase mobility and slow the progress of this condition.
If you suffer from Low Back Pain come and see us at Kinetic Health. In the majority of cases we can help!
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publications which will be available later this year.
Make Your Appointment Today!
Make an appointment with our incredible team at Kinetic Health in NW Calgary, Alberta. Call Kinetic Health at 403-241-3772 to make an appointment today, or just click the MSR logo to right. We look forward to seeing you!
Lumbar degenerative disk disease., Modic MT, Ross JS. Radiology. 2007 Oct. 245(1):43-61. [Medline].
Operative and nonoperative treatment approaches for lumbar degenerative disc disease have similar long-term clinical outcomes among patients with positive discography., Smith JS, Sidhu G, Bode K, Gendelberg D, Maltenfort M, Ibrahimi D, Shaffrey CI, Vaccaro AR. World Neurosurg. 2014 Nov;82(5):872-8. doi: 10.1016/j.wneu.2013.09.013. Epub 2013 Sep 15.
Fascia research II. Basic science and implications for conventional and complementary health care., Findley T, and Schleip R. (2009). Introduction. In: Huijing PA, Hollander P, Findley TW, and Schleip R, eds. München: Urban and Fischer.
Fascia: The Tensional Network of the Human Body - E-Book: The science and clinical applications in manual and movement therapy., Schleip R, Findley TW, Leon Chaitow L, and Huijing PA. (2012). Canada: Elsevier
An improved Collagen Scaffold for Skeletal Regeneration, Serafim M. Oliveira, MS, PhD, Rushali A. Ringshia, MS, Racquel Z. LeGeros, PhD, Elizabeth Clark, MS, Michael J. Yost, PhD, Louis Terracio, PhD, and Cristina C. Teixeira, DMD, MS, PhD, J Biomed Mater Res A. 2010 Aug; 94(2): 371–379.