Low Back Degenerative Disc Disease: What It Means & How to Treat It!

"MRIs can paint a scary picture! Fortunately in many instances, degenerative disc disease (DDD) is NOT as daunting as it sounds. Physical Therapy should be the first line of defense in treating DDD."
-Dr. Jim Heafner PT, DPT, OCS

Overview

• Degenerative Disc Disease (DDD) is commonly referred to as osteoarthritis or arthritis 
• DDD is a natural aspect of aging, but can also occur due to a traumatic injury 
• MRI studies have found many people without any pain or low back problems to have DDD. This means that DDD does not cause pain!  
• In many instances, it is not the cause of a person’s pain. It is only a symptom! 
• Long term studies show equal outcomes between conservative treatment and surgery

What is Degenerative Disc Disease (DDD)​

The spine is made of 24 vertebrae and divided into three separate regions. The lowest of the three regions is known as the lumbar spine or low back, which has five vertebrae. Between each vertebrae there is a dense piece of connective tissue called a disc. DDD is degeneration of one or multiple discs in the spine.

Currently scientists and researchers have not identified a single cause of DDD; however, they have found several predisposing factors. First, DDD is thought to be a natural progression of age. Much like the body ages externally, it will also age internally. DDD has been compared to the wrinkles on one’s face or the gray hair that develops over time. Second, DDD may occur after a traumatic injury such as a bicycle accident or motor vehicle wreck. A traumatic injury is thought to expedite the degenerative process and potentially predispose a person to early arthritis. Finally, factors such as smoking have been linked to DDD. Smoking decreases the oxygen supply to the discs and does not promote proper nutrition or healing of the disc.

Symptoms of DDD

Individuals with DDD often have a gradual onset of low back pain. Symptoms may be located in the midline of the back or isolated to one side. Pain is often described as dull or achy and generally greater in the morning. Since DDD is often a natural aspect of aging, many individuals often have several episodes, each with a different duration of time. Pain and stiffness is more likely to be present after resting in a prolonged posture or performing a repetitive activity. 

If symptoms of DDD worsen, pain can spread to the buttock or thighs. In these instances, other structures of the spine such as the nerves or muscles, may be receiving extra stress. 

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Treatment of DDD

Degenerative Disc Disease is commonly treated conservatively with a combination of physical therapy and NSAIDs. The goal of these treatments should be to minimize pain and gradually return people to their normal activities as quickly as possible. A quality rehabilitation program should include a combination of joint manipulation, core and hip strengthening exercises, spinal mobility exercises, and aerobic conditioning. Research has shown little effectiveness for modalities such as TENS or ultrasound. 

If conservative management fails, an orthopedic surgeon or neurosurgeon will make the decision to perform more aggressive interventions. Individuals who require surgery often have advanced symptoms and debilitating pain. Patients should be aware that long term outcomes of conservative management and surgery are similar at a 10-year follow-up of patients with degenerative disc disease. 

For questions or treatment advice, call Heafner Health Physical Therapy.
(Heafner Health is located in Boulder, Colorado 80301)

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References:
1) http://morphopedics.wikidot.com/degenerative-disc-disease
2)http://www.synergyptnc.com/Injuries-Conditions/Lower-Back/Lower-Back-Issues/Lumbar-Degenerative-Disc-Disease/a~48/article.html