WHAT IS IT?
Degenerative Disc Disease (DDD) is the degradation of discs in the spine as a result of signs of aging, or wear and tear of discs. Common signs is back or neck pain that can feel like an ache, throb or even sharp shooting pain. There is also stiffness and decreased ability to turn head or back to side such as when checking shoulder or looking back when backing up a vehicle. Turning and twisting torso is also painful and limited. There may also be some muscle weakness. Pain and stiffness are usually worst in morning and improve with mobility as the day progresses eventually becoming worse again at night.
DDD is considered to be a misnomer because it is not actually a disease. However, it is consistent with the widespread use of the word to denote something that causes distress, or “dis-ease”.
Function, Aging, and Symptoms
The function of the disc is to allow movement of the spine, cushion against forces, and provide height. The discs itself do not have direct blood supply; the cells within the disc are sustained through diffusion of nutrients from the vertebrae. Due to the lack of blood supply, the discs are unable to repair themselves when injured. Disc degeneration is a normal process in all people as a result of aging. Many individuals with a degenerated disc are asymptomatic and are not affected by the degenerative changes. It isn’t diagnosed as DDD until the degenerative disc begins to cause pain with or without radiating weakness or numbness in the back/neck and limbs stemming from a degenerated disc.
Factors and Prognosis
Factors that cause degeneration include: aging, genetics that result in accelerated aging, dehydration of the disc, wear and tear sustained from daily activities at home or work, sports injuries, and workplace injuries and motor vehicle accidents.
It is reported that approximately 90% of those with lower back pain will have symptoms resolved within 3 months. Most have a cessation of discomfort within 6 weeks.
Spinal mobilization (manual therapy), Strengthening of core muscles (e.g. abdominal wall, neck and lower back muscles), education on better body mechanics, increase in activity, and exercise have all been shown to decrease the symptoms of DDD.
To maintain the benefits of physiotherapy, patients should continue to remain active and exercise outside of visits to the physiotherapist. Lifestyle modifications are also important to reduce the symptoms such as maintaining good posture and modifying activities that may provoke pain. Other lifestyle changes such as quitting smoking and eating healthy to promote good disc health, losing weight to reduce the stress on the back should be encouraged.
NSAIDs (nonsteroidal anti-inflammatory drugs) are effective for short-term symptomatic relief. The use of narcotics for long-term pain relief should be avoided due to their pain-masking effects and other multiple side effects.
Surgery is only considered when conservative options have been exhausted. To date, arthrodesis (joint fusion) remains to be the best surgical option for patients with DDD.
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