Degenerative disc disease (DDD), also known as spinal arthritis, is the breakdown, bulging, and loss of disc height over time of the intervertebral discs of the spine.
Although it’s labeled as a disease, DDD is often asymptomatic (no symptoms) in most people.
This is a normal aging process that is not strongly associated with low back pain.
With that being said, DDD can become severe enough that you develop stenosis of the spine either at the lateral aspect around the foramina or of the central canal.
This spinal stenosis can lead to nerve symptoms down one or both legs, or one or both arms.
Spinal stenosis is not always symptomatic (causing symptoms), and can oftentimes be treated without surgery, thankfully.
While it’s not possible to make stenosis “go away,” we can often modify and reduce symptoms associated with this through exercise, stretching, and sometimes medication and injections.
- Degenerative disc disease is usually not a cause for concern
- Loss of hydration of the disc, a decrease in proteoglycans, and a decreased tissue load resistance due to aging is what causes degenerative disc disease.
- Many people have DDD and don’t even know it. They have no symptoms.
- Just because you have DDD does not mean that someday you will have symptoms. It’s unknown who and who will not develop symptoms.
- The best treatment method for DDD is to stay active, stop smoking, and avoid movements that continually aggravate it. If you want to continue to do the activity that aggravates it, come up with a plan to get back to that activity with your physical therapist.
Is degenerative disc disease a cause for concern?
In most cases, degenerative disc disease is not a cause for concern.
Disc bulges are very normal and are a part of the aging process.
It is true though that people who have more degenerative changes in their spine do often times present with more symptoms.
In any case, surgery is rarely the solution for DDD.
At the end of this post I will discuss different treatment options for DDD and provide a link to several videos that i’ve made about what the best types of exercises to do for symptomatic DDD are, with instructions.
I know I’ve already said this, but I want to reiterate that degenerative disc disease is a normal part of the aging process and is often times not symptomatic.
Even if it is symptomatic you can do a lot of different treatment methods that can help out a ton.
No need to fret.
What causes degenerative disc disease?
Aging is the primary cause of degenerative disc disease.
Keep in mind that these are all proposed causes of degenerative disc disease and it’s not possible to know at this time with our current research abilities to know which one contributes more or less.
- Mechanical load over time
- Nutritional interactions
- Genetics or familiar hereditary factors
I’ve looked through the data and none of it is very conclusive as to what is the primary cause.
Lifestyle factors that increase the odds of DDD are:
- Heavy physical labor (not exercise)
- Physical inactivity
You can read this scientific article to get more nitty-gritty details of those interactions.
What are the cellular mechanisms leading to degenerative disc disease?
Here are the main cellular mechanisms behind degenerative disc disease and disc bulging.
“The main factor in the degeneration of the intervertebral disc is the loss of proteoglycans. These large molecules are degraded to smaller fragments that are lost from disc tissue (12,13). The consequence is fall in osmotic pressure in the disc matrix and loss of water molecules, which affects the mechanical properties of the disc (12, 14, 15). As degenerated intervertebral discs contain less water and have therefore inferior capabilities for sustaining pressure, they bulge and loss height. Proteoglycan loss affects also movement of other molecules into and out of the disc matrix. Serum proteins and cytokines diffuse into the matrix, affect the cells and accelerate the process of the degeneration (5, 13, 15).”
To summarize the cellular mechanisms:
- Loss of proteoglycans
- What is a proteoglycan (a protein molecule that has many attachments to sugar molecules
- Why is this important in the intervertebral disc?
- “Collagens provide form and tensile strength while proteoglycans, through interactions with water, give the tissues stiffness, viscoelasticity, and resistance to compression. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2335383/
- What happens to intervertebral discs when they lose proteoglycans?
- Loss of stiffness
- Decreased water content due to decreased osmotic pressure
- Disc bulging
- Decreased disc height (this is why you get shorter as you age)
- Loss of disc height and bulging leads to more cytokine and serum protein release which then leads to further degenerative changes.
- Another article I wrote discusses how fast DDD changes.
Will you always have symptoms with degenerative disc disease?
This excerpt is taken from a scientific article that I will link to below so you can also verify.
Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.
Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition.”
As you can see, spine degeneration is very normal and is often times asymptomatic.
If you are having symptoms it may or may not be related to disc degeneration.
Going to your doctor or physical therapist to be evaluated if you are having pain is the best option and they will be able to guide you to the right decision for your specific situation.
How is degenerative disc disease diagnosed?
Degenerative disc disease is not so much a diagnosis as it is a definition of findings.
Here’s why it’s not really a diagnosis:
A diagnosis is defined as: “the identification of the nature of an illness or other problem by examination of the symptoms.”
If it’s not causing pain, disability, or any other problems, then it’s not a true illness and can’t be described as a diagnosis.
So, when people go in to get an x-ray or MRI of their back, I expect, nearly 100% of the time for there to be some amount of degeneration of the spine.
This does not help me with my diagnosis of potential root causes in most cases.
The most important thing when it comes to cervical, thoracic, or lumbar spine pain is what your symptoms are.
Your symptoms, regardless of the diagnosis, are going to dictate what type of treatment you receive.
In 99% of cases for any type of back pain you are going to be referred or should be referred to physical therapy.
It’s also worth noting that most back pain gets better in a time span of 2-6 weeks.
Here is the American Academy of Family Physicians’ recommendations for Low Back Pain (this applies to all back pain):
- Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, should be used initially for most patients with acute or subacute low back pain, as they will improve over time regardless of treatment.
- When pharmacologic treatment is desired, nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants should be used.
- Nonpharmacologic treatment, including exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, cognitive behavioral therapy, or spinal manipulation, should be used initially for most patients who have chronic low back pain.
- For patients who have chronic low back pain and do not respond to nonpharmacologic therapy, NSAIDs should be used. Tramadol or duloxetine should be considered for those patients who do not respond to or do not tolerate NSAIDs. Opioids should only be considered if other treatments are unsuccessful and when the potential benefits outweigh the risks for an individual patient. See full recommendation for further details.
What symptoms does DDD produce?
If you do have symptomatic DDD, this may or may not be related to stenosis.
Symptoms generally consist of dull, achy pain, that oftentimes will be worse in the morning but gets better as you get warmed up.
If you develop stenosis as a result of DDD you may experience nerve symptoms such as numbness, tingling and/or burning down one or both limbs.
If you ever experience worsening numbness, tingling, weakness, and bowel or bladder changes then you should visit your doctor ASAP as this amount of compression could be causing damage to the nerves.
What are the treatment methods for DDD?
There aren’t any treatment methods to reverse the actual degeneration of the disc material itself. There are treatments for symptoms associated with DDD.
If you have back pain there are many non-surgical options that you should try before you decide to go down that route.
Earlier in this post, I shared recommendations from the AAFP about what to do about back pain.
First line of treatment is:
- Manual manipulation
- Non-steroidal anti-inflammatory medications, muscle relaxants
As the guidelines also state, most back pain will improve within 2-6 weeks regardless of treatment.
Put in other words… you could literally do anything and it will get better.
If you are having symptoms longer than that and are getting frustrated they are taking so long to improve please go see your doctor or physical therapist that you trust.
If you need additional help you can always contact us and get a consultation setup!