Is Degenerative Disc Disease
Causing Your Lower Back Pain?

Not all lower back pain is the same. Degenerative disc disease can mimic other spine conditions. If you have sciatica symptoms and severe back pain they can be caused by DDD or other spine issues. How do you know if you have DDD? If you do, what are the best treatment options?



What is Degenerative Disc Disease?

The spine is comprised of bony vertebrae separated by discs. These discs function to help provide cushioning and allow movement. Discs are comprised of a jelly like center called the nucleus pulposus and a thick fibrous ring called the annulus. As we all get older, these discs lose their hydration, causing the discs to become thinned. Degenerative disc disease is the result of these thinning discs.


Spinal degenerative disc disease


Most commonly, symptoms of DDD occur gradually over time. A previous history of spine issues is common. And, because of the generative nature of this condition, persons suffering from DDD are generally over the age of 50.


Symptoms of DDD

Lower back pain associated with DDD can have a variety of signs and symptoms. Generally, activities involving being in a weight bearing position can aggravate symptoms. Thus, standing and walking are more aggravating than sitting. Transitional movements such as moving from sitting to standing are also aggravating. Often symptoms in the morning are elevated and improve with movement and activity.

DDD symptoms most often radiate across both the left and right lower back but less frequently create sciatica symptoms or symptoms radiating down into the legs. Movement of the lower back into an extended or arched position can be both limited and painful. When experiencing symptoms related to DDD, complaints of stiffness are as frequent as complaints of pain.


How is DDD Diagnosed?

X-rays are the most common diagnostic tool used to determine the presence of DDD. An x-ray will show the spacing between the vertebrae and indicate if narrowing has occurred.



Typical Treatment of DDD

As with many degenerative issues, the use of anti-inflammatory medication is a treatment option (consult your doctor regarding medication). Another valuable means of reducing inflammation is utilizing ice therapy. To assist in reducing low back inflammation, ice your low back, 10 to 15 minutes, three times a day. Minimize inflammation also by avoiding those activities that aggravate symptoms.

When oral anti-inflammatory medications are not effective in reducing lower back pain, epidurals may be recommended. The best practice for performing epidurals is to do them under fluoroscopy which is simply utilizing an x-ray during the injection in order to help the doctor visualize exactly where the injection should be place. Generally up to three epidurals will be given.

As symptoms of DDD are aggravated by compression of the disc, decompression can help to minimize symptoms. One way to help decompress the discs is to use the 90-90 position. This position can be combined with ice therapy for added benefit.


90-90 position


Another means of providing this decompression is the use of an inversion table. Inversion devices utilize the weight of the upper body to create a traction effect on the spine, decompressing the disc.


Inversion Table


Physical Therapy

Manual physical therapy can be greatly helpful in reducing DDD related pain. The use of joint mobilizations and soft tissue can help to improve spine mobility. Modalities such as ultrasound and TENS can also assist in reducing pain.

Finally, the use of stretches and strengthening exercises are valuable in reducing symptoms related to degenerative disc disease. As stiffness is a primary complaint, stretches involving flexing and slightly rotating the low back can be effective in minimizing these symptoms.

Pain free strengthening exercises for the abdominal and low back extensors can help to minimize the sheer force that contributes to degenerative disc disease pain. Muscles act as shock absorbers thus strong core muscles can help to minimize disc stress.

Click here for more detailed information on degenerative disc disease exercises.


Surgery

Generally, DDD alone does not warrant surgical intervention. In significant cases the disc degeneration can also create spinal stenosis. Under these conditions the presence of leg pain and weakness can create additional functional issues. As with any spinal condition, surgery should be approached with extreme caution. Only when conservative treatment of anti-inflammatory medications, ice, epidurals, and physical therapy has failed should surgery be considered. In such cases, a spinal fusion and/or laminectomy is generally recommended.


Summary

• DDD is the reduction of disc height secondary to a loss of disc hydration.

• Symptoms occur most often across the lumbar spine and are aggravated with standing and walking.

• Conservative treatment includes anti-inflammatory medication, ice, epidurals, and physical therapy.

• To minimize pain and improve function, follow these exercise recommendations: degenerative disc disease exercises.

• Surgery is an option of last resort and should only be considered when conservative treatment has failed.


Degenerative disc disease is a common lower back condition that is treatable. Take control of your symptoms by being consistent with these recommendations.




References

Orthop Clin North Am. 2011 Oct;42(4):xi-xii.Lumbar intervertebral disk degeneration.Samartzis D, Cheung KM.

Orthop Clin North Am. 2011 Oct;42(4):487-99, vii.Biomechanics of intervertebral disk degeneration.Inoue N, Orías AA.

Orthop Clin North Am. 2011 Oct;42(4):513-28, viii.Management of degenerative disk disease and chronic low back pain.Karppinen J, Shen FH, Luk KD, Andersson GB, Cheung KM, Samartzis D.


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