Degenerative Disc Disease -DDD
Updated: May 11
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 almost immediately there will be a reduction in 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 the 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 the intervertebral discs of the lumbar spine. Updated Material!
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 the 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 an 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 on the outside of the disc (Annulus Fibrous) moving inward, this enables ingrowth 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.
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:
First…Improvement of joint mobility.
Second…Reduction of pain and stiffness.
Third…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. 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.
MYOFASCIAL RELEASE & JOINT MOBILIZATION
When your 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.
Just as important as releasing the myofascial system is addressing joint mobility. Manual therapy cannot reverse degeneration, but it can increase mobility, decrease pain, and help improve function.
Here are some example 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 I demonstrated 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.
Lumbar Spine Joint Mobilization - MSR: Our capacity to produce an unlimited variety of movements requires good joint integrity. No joint ever works in isolation. An injury in one joint often results in bio-mechanical compensations occurring in both adjacent and distant joints. Research has shown that spinal mobilization/manipulation is an effective component of an overall treatment strategy for relieving pain (local and radiating pain) in patients who suffer from back pain and sciatica. (This video will be available of the public on July 2/2020).
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 exercises that work well for one individual, may cause problems in the next. Over all though there are fundamental components that any exercise program must include:
Flexibility: to increase joint mobility, reduce pain and stiffness. A great example is the Cat Camel exercise. This is a great spinal mobilization exercise. If you are suffering from back pain avoid intense exercises that involve stretching or bending first thing in the morning. Give your body time to warm up. It takes about an hour for the extra fluid in your spinal discs to be squeezed out through normal motion. Click on the image to view the video.
Strengthening: Lack core stability , is often a major issue in Degenerative Disc Disease. Strengthening exercises should only be assigned after the flexibility exercises have restored some movement to the spine. Strengthening exercises are critical if one is to obtain long-term, sustainable progress. The Front Plank is an example of a great core exercise. In this video, we show you how to perform both the Beginner and the Standard plank. Both are great core exercises that work to stabilize the shoulder and strengthen the muscles of your core. Ensure that you only do this exercise within your pain-free zone.
Aerobic exercise: helps to reduce pain, encourages a healthy body weight, improves energy production (ATP), and promotes circulatory function. Go for bike ride, get out walking, or get into the swimming pool.
Activities of Daily Living
Activities of Daily Living: If you are suffering from back pain due to DDD you need to consider how you lifting, your sleeping positions, brace your core, and avoid positions that are causing you pain. Take a look this video we put together to help you with these important factors.
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. In the majority of cases we can help!
Modic MT, Ross JS. Lumbar degenerative disk disease. Radiology. 2007 Oct. 245(1):43-61. [Medline].
Smith JS, Sidhu G, Bode K, Gendelberg D, Maltenfort M, Ibrahimi D, Shaffrey CI, Vaccaro AR. Operative and nonoperative treatment approaches for lumbar degenerative disc disease have similar long-term clinical outcomes among patients with positive discography. World Neurosurg. 2014 Nov;82(5):872-8. doi: 10.1016/j.wneu.2013.09.013. Epub 2013 Sep 15.
Findley T, and Schleip R. (2009). Introduction. In: Huijing PA, Hollander P, Findley TW, and Schleip R, eds. Fascia research II. Basic science and implications for conventional and complementary health care. München: Urban and Fischer.
Schleip R, Findley TW, Leon Chaitow L, and Huijing PA. (2012). Fascia: The Tensional Network of the Human Body - E-Book: The science and clinical applications in manual and movement therapy. Canada: Elsevier
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 An improved Collagen Scaffold for Skeletal Regeneration J Biomed Mater Res A. 2010 Aug; 94(2): 371–379.
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.
Dr. Abelson is the owner of Kinetic Health, a partner in BKAT Motion Specific Release, and a partner in Rowan Tree Books.