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What are some things to avoid with degenerative disc disease?

There are some things to avoid with degenerative disc disease.  However, know that degenerative disc disease is very common.  I have seen a lot of MRI reports on the low back.  If the patient is over 40 years old, there is a good chance that I am going to see degenerative disc disease or DDD on it.  Patients areunderstandably are concerned.  After all, it sounds like a disease that involves their spine.  It might seem scary but, in reality, it is a normal process of aging.  It is more of a wear and tear on the spine.  It can cause low back pain but, in many cases, it doesn’t.

 

Tell me about the spine.

In order to understand DDD, you need to be familiar with the structure of the spine. The spine is made up of 33 vertebrae.  The vertebrae are the bones of the spine.  Each is stacked on top of one another to make a column.  The spinal cord travels through the column with nerves exiting at each vertebral level.  The first 7 vertebrae make up the cervical or neck region.  The middle 12 vertebrae are the thoracic or mid back region. The next 5 vertebrae are the lumbar or low back.

“Radiopaedia – Drawing Iliotibial band – English labels” by Matt Skalski, license: CC BY-NC-ND

The next five make up the sacrum which is the triangular bone at the base of the spine.  The sacral vertebrae are fused meaning they have grown together.  The last 4 vertebrae are also fused.  This is the coccyx or tailbone.  The discs are in between the cervical, thoracic, and lumbar vertebrae.  The sacrum and coccyx have grown together and have no space between the vertebrae for a disc.

So what does the disc do?

The spinal discs are the shock absorbers of the spine.  The disc sits in between each vertebrae and creates space between the vertebrae.  This space allows the joints and the spine to move freely.   The disc has very dense and tough outer rings and a soft, jelly-like core.  This allows it to absorb the various forces through the spine.  As we age the disc begins to dry out and lose height, and the boney vertebrae become closer together.  This is DDD.  It can lead to bony spurs or osteophytes which can cause inflammation and pain.  However in many cases DDD does not cause any pain at all.

What are the symptoms of DDD?

  • Low back pain that increases with sitting for long periods
  • The pain can be episodic and last for weeks or months before it calms down
  • Pain can radiate down the low back into the buttocks
  • The pain increases with rotating, bending, or lifting
  • The pain improves with changing positions, activity, and lying down

Are there risk factors?

Since DDD is a natural process of aging, many of us will get it just by living long enough.  However, there are risk factors for more severe and symptomatic DDD.  These include:

  • Smokers
  • Obesity
  • Having an occupation that requires heavy physical labor
  • Sedentary lifestyle

Is it preventable?

Unfortunately, DDD is not preventable.  However you can decrease your risk with changes in lifestyle.  These lifestyle changes can also decrease the progression of DDD.  These changes include:

  • Stop smoking – Smoking can cause the disc to dry out and lose height. This also increases the risk of injury, including herniation, to the disc.
  • Avoid alcohol and sodas – Similar to smoking, drinking alcohol and sodas can play a role in drying out the discs.
  • Drink more water – Drinking plenty of water helps maintain joint, organ, and spine functions.
  • Use proper lifting techniques – This decreases stress and the risk of injuries on the disc.
  • Exercise regularly – This improves joint health as well as spinal mobility and stability.
  • Maintain a healthy body weight – This helps limit the stress placed on the spine.
  • Have good posture – This keeps the spine in good alignment and decreases stress on the spine.

Can PT help?

Of course, PT can help!  In fact, PT is the preferred treatment for those with pain resulting from DDD.  Your physical therapist can help improve the mobility of your spine and improve your pain with manual therapy.  They can help improve your flexibility, strength, and stability of your spine and hips with stretches and strengthening exercises.  PT can also help with strategies to help you manage episodes of pain in the future.

What can I do at home?

There are several things that you can do to help improve your spine health and decrease your pain.  These include:

  • Lifestyle change – These are the changes that I have already mentioned. All of these changes will help decrease low back pain and the progression of the DDD.
  • Exercise
    • Aerobic – Performing low impact aerobic exercise is very beneficial for the spine. It increases the flow of nutrients and blood and decreases pressure on the discs.  Examples of low impact aerobic exercise include walking, swimming, and biking. If you don’t currently have an exercise program, then carefully work into one.  You might begin by walking for 5 to 10 minutes a day and slowly work up to 30-60 minutes over several weeks or months.
    • Stretching – Stretching the muscles of the back and hips will increase your range of motion, improve posture, and decrease tension around the low back.
    • Strengthening – Strengthening the muscles around the low back and hips will help stabilize the spine and will allow the discs to resist higher loads. Below are videos of strengthening and stretching exercises for the low back.  Using resistance bands is a nice economical way to increase difficulty and strength.

  • Heat and ice – Heat is helpful when the back is feeling stiff, like in the morning when just getting up. It can bring blood flow to the area and make movement more comfortable.  Sitting on a heat pack for 15 minutes prior to exercise could be helpful in improving back mobility.  Ice can be used to decrease inflammation after activity such as exercise, yard work, or heavy lifting.  Ice the area with an ice pack for 15 to 20 minutes to decrease pain and inflammation.
  • Other things you can do
    • Consult with your physician – If PT is not helping or the pain is still interfering with your daily function, then you might need further medical intervention. Your physician can prescribe medication and order imaging that can track how fast your DDD is progressing.
    • Gentle yoga – This is nice way to stretch and strengthen in a relaxing environment. It can improve strength and mobility while decreasing stress.

In review

  • DDD occurs when the disc between the vertebrae dry out and lose height.
  • It is considered a normal process associated with aging.
  • There are lifestyle changes that can help decrease your risk of developing it or slow it down if it is already present.
  • PT is one of the preferred treatments for DDD.
  • There are several things that you can do to help manage your pain:
    • Light aerobic exercise
    • Stretching
    • Strengthening
    • Heat and ice
    • Consulting your physician
    • Gentle yoga

As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.

Additional resources

https://www.choosept.com/guide/physical-therapy-guide-degenerative-disk-disease

https://www.physio-pedia.com/Degenerative_Disc_Disease

https://www.statpearls.com/articlelibrary/viewarticle/24451/