Degenerative Disc Disease and Low Back Pain

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Degenerative Disc Disease (DDD) is a gradual process that may compromise the spine. Although DDD is relatively common, its effects are usually not severe enough to warrant medical attention. In this discussion we address Degenerative Disc Disease in the lumbar (low back) spine.

Degenerative Changes to a Disc
Degenerative changes in the spine are often referred to those that cause the loss of normal structure and/or function. The intervertebral disc is one structure prone to the degenerative changes associated with wear and tear aging, even misuse (e.g. smoking).

Long before degenerative disc disease can be seen on an x-ray, biochemical and histologic (structural) changes occur. Some of these changes are similar to those associated with osteoarthritis.

Over time the collagen (protein) structure of the annulus fibrosus weakens and may become structurally unsound. Additionally, water and proteoglycan (PG) content decreases. PGs are molecules that attract water. These changes are linked and may lead to the disc’s inability to handle mechanical stress. Understanding the lumbar spine carries a large portion of the body’s weight; the stress from motion may result in a disc problem (e.g. herniation).

Non-Operative Treatment: Yesterday vs. Today
DDD is a disorder that may cause low back pain. It is interesting to note that although 80% of adults will experience back pain, only 1-2% will need lumbar spine surgery!

In the past some physicians prescribed long courses of bed rest and/or lumbar (low back) traction for their patients with low back pain. However, that is not the attitude today. During the acute phase, bed rest may be recommended for a few days, but beyond that experts advocate stretching, flexion and extension exercises, and no/low impact aerobics. Of course, each patient is different and therefore so is their treatment plan.

Therapeutic Exercise
In some patients, the pain response may limit flexibility. Prescribed stretching exercises can improve flexibility of the trunk muscles. Flexion exercises may help to widen the intervertebral foramen. The intervertebral (between the vertebrae) foramen are small canals through which the nerve roots exit the spinal cord. The intervertebral foramen are located on the left and right sides of the spinal column.

Extension exercises, such as the McKenzie method, focuses on the muscles and ligaments. These exercises help maintain the spine’s natural lordotic curve, important to good posture.

Aerobics (no/low impact) offers many benefits including improved muscular endurance, coordination, strength, strong abdominal muscles, and weight loss. Strong abdominal muscles work like a brace (or corset) to reduce the loads to the lumbar spine. It is also known that aerobics help to combat anxiety and depression. The loads on the discs during walking are only slightly greater than when lying down. Walking, bicycling, and swimming are forms of aerobic exercise a physician may suggest.

Acupuncture
Acupuncture, a type of alternative medicine, has been shown to help control pain. It has been suggested that acupuncture stimulates the production of endorphins, acetylcholine, and serotonin. However, acupuncture should be combined with an exercise program for many of the reasons outlined in prior paragraphs.

Drug Therapy
During the acute phase of low back pain, drugs may be prescribed. Some may include acetaminophen, anti-inflammatory agents, muscle relaxants, narcotics, and anti-depressants. Narcotics are used on a short-term basis partly due to their addiction potential. When low back pain is caused by muscle spasm, a muscle relaxant may be prescribed. These drugs have sedative effects. Depression can be a factor in chronic low back pain. Anti-depressant drugs have analgesic properties and may improve sleep.

Manipulation
Today manipulation is performed by Chiropractors and Physical Therapists. For patients without radiculopathy (pain stemming from a spinal nerve root), manipulation may be effective during the first month. Thereafter, benefits are unproven. Manipulation is believed to be effective because of its effect on spinal mobility. Acute low back pain, chronic low back pain, and degenerative disc disease without nerve compression may respond to manipulation.