Degenerative Disc Disease

Degenerative disc disease refers to symptoms of back or neck pain caused by wear-and-tear on a spinal disc. Degenerative disc disease typically consists of a low-level chronic pain with intermittent episodes of more severe pain. Painful disc degeneration is common in the neck (cervical spine) and lower back (lumbar spine). These areas of the spine undergo the most motion and stress and are most susceptible to disc degeneration. In some cases, degenerative disc disease also causes weakness, numbness, and hot, shooting pains in the arms or legs (radicular pain).

Degenerative disc disease is an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column deteriorates or breaks down, leading to pain. Despite its name, degenerative disc disease is not a disease, but a natural occurrence that comes with aging.

Although the spine is in a near-constant state of degeneration after the age of 20s, most people don’t start to experience symptoms of DDD until they reach their 60s or 70s, Symptoms usually get worse with age. The discomfort can range from mild to severe and debilitating. It can lead to osteoarthritis, with pain and stiffness in the back. The most common early symptom is usually pain and weakness in the back that radiates to another area. Symptoms vary widely and may include:

• Feeling like back has “seized” or “locked up” 
• Neck pain
• Loss of motion in the spine
• Stiffness in the back
• Pain that radiates through the buttocks and legs or arms and hands
• Pain that worsens with extended periods of sitting
• Leg or foot weakness in severe cases

Degenerative disc disease (DDD) develops as a result of the effects of aging on your spine and specifically on your intervertebral discs. It can also be associated with an injury to the back, but even in that scenario, your discs have usually become weak because, with age, discs lose water content, may become thinner; both of which can alter the strength and shape of one or more discs. Common causes include:

• Injuries. Any back injury that causes swelling or soreness – from a car accident to that one wayward swing on the golf course – can increase the risk of DDD.
• Genes. DDD tends to run in families, though scientists haven’t identified the genetic marker(s) known to increase risk. 
• Spinal diseases. Certain back conditions, such as ankylosing spondylitis (an inflammatory spine condition that causes vertebrae to fuse), can increase the risk for DDD.
• Excess weight. Being overweight and obese increases the load your spine has to bear. That excess weight compresses the spinal discs. Compared with normal-weight people, those who are overweight and obese are more likely to have significant disc degeneration.
• Smoking. Some evidence suggests that smoking contributes to the degeneration of spinal discs.

The doctor will ask about symptoms, when and where the pain occurs, whether there is tingling or numbness, and which situations cause the most pain. They will also ask about any falls, injuries, or accidents. A physical examination may assess for:

• Muscle strength: The doctor may check for atrophy, wasting, or abnormal movements.
• Pain with motion or in response to touch: The patient will be asked to move in specific ways. If the pressure applied to the lower back cause pain, there may be a degenerated disc.
• Nerve function: The physician taps different areas with a reflex hammer. Poor or no reaction could indicate a compressed nerve root. Hot and cold stimuli may be used to see how well the nerves react to temperature changes.

The doctor may order the following diagnostic tests:

• Imaging scans, such as CT or MRI, to gather information about the state of the spinal nerves, the discs, and how they are aligned.
• A Discogram, which involves injecting a dye into the soft center of the disc, or several discs. The aim is to see whether the disc is painful. The dye shows up on a CT scan or X-ray. Discogram usage may be controversial, however, because herniated discs do not always cause symptoms.

Physical therapy is often suggested or prescribed to help maintain healthy mobility in the spine.

• Stretching exercises for muscles in the low back, hips, and pelvis, as well as the hamstring muscles. Tightness in these muscles places more pressure on the lumbar spine and contributes to low back pain.
• Strengthening exercises that build lower back and abdominal muscles to maintain healthy postures and better support the spine. Strengthening exercise programs might include a customized physical therapy program, dynamic lumbar stabilization, tai chi, Pilates, or others.
• Low-impact aerobic exercise that elevates the heart rate to improve circulation and deliver nutrients and oxygen necessary for healing the body’s tissues. Examples of aerobics that are gentle on the spine include walking, swimming and water aerobics, stationary biking, and running on an elliptical.
• Heat and ice. Applying heat to the low back improves circulation, which reduces muscle spasms and tension and improves mobility. Ice packs can reduce inflammation and numb mild pain. It can be helpful to apply heat before physical activities to relax the muscles and to apply ice after activity to minimize inflammation.
• Massage therapy. Massage therapy can reduce tension and spasms in the low back muscles, reducing pressure on the spine and alleviating pain. Additionally, massage therapy can improve circulation, providing healing nutrients and oxygen to tense muscles.