Disc degeneration: Part of aging process
Degenerative disc disease is a somewhat deceptive term because it is not really a disease and it is frequently used interchangeably with “bulging disc”. This common problem of the spinal discs is absolutely not a disease and it is not contagious or transferable. People who have this problem, with the customary neck pain or lower back pain, are only experiencing the effects of the normal aging process – part of the joys of getting older.
Most of the time, disc degeneration is a natural consequence of aging. It can be said that degenerative disc disease is basically arthritis of the disc that happens as a result of accumulated mechanical wear and tear on the spine.
However, it can sometimes happen that the discs in an area of the spine will degenerate prematurely when the patient is still relatively young and active. In these cases it causes a variable amount of spinal pain at or near the level of disc thinning.
All discs will degenerate over time. However, some people abuse themselves more and earlier than other people, and will develop degenerative disc disease sooner than average. In these situations the early degeneration that can happen even in the later teen years as a result of a specific injury to the spine. Severe disc injury can occur during an automobile accident, or after small repeated injury and abusive as from sports or early farm work, eventually leading to degenerative disc disease.
With age, discs typically become dried out and thinner than normal. This process is seen on x-ray examination in most adults in their mid-thirties; or in about 20 percent of people in their twenties and in 100 percent of people by their sixties.
Degenerative disc disease is not something that begins in the later years of life. It only reaches the worst stages and most pain in the elderly, although if the disc abuse starts early in some people it can also be painful early in life. This is a process that develops slowly and usually takes time to make itself known. Degenerative disc disease usually starts at a much younger age than people realize because it is commonly painless in the early stages.
Spinal disc structure and function
Each spinal disc is a spongy or springy tissue due to its high water content of water. This quality helps it to function as a cushion or shock absorber between the two spinal bones it is placed between. Discs also serves to act as a spacer and to create a joint between these vertebrae. The thick and spongy nature of the disc allows for controlled rocking and slight rotation movement between vertebrae.
As it naturally dries with age, and spinal disc degeneration occurs, the disc will narrow and stiffen. In this dehydrated condition the disc loses the ability to function as a shock absorber and spacer, no longer allowing for full and smooth movement between vertebrae. Further, a dehydrated disc is more susceptible to inflammation and pain.
The inflammation of a degenerate disc causes mechanical pain due to stretching in some areas of the disc and compression in other areas. The pain symptoms if any are mild and transient in the early years of development, and gradually worsen over time. Pain presents as low back pain sometimes with sciatica, or neck pain sometimes with arm pain and numbness.
The pain of a thinning and weak disc is typically aggravated by activity and relieved by rest and lying down, although there are exceptions. Too much rest and inactivity can aggravate degenerative disc disease by allowing edema or accumulation of tissue fluid around the thinning joint to develop. Pain develops because the accumulated fluid puts pressure on nerves in the area. Also, mild and controlled activity can relieve the pain of degenerative disc disease by helping to move the accumulated edema fluid from the area. This is why a person with a degenerated disc will often feel worse when first getting out of bed or from a chair after prolonged inactivity, but will rapidly feel looser and less painful within a few minutes after starting to move around.
As degenerative disc disease slowly progresses, small fissures and cracks develop along the edges of the disc. These structural changes eventually lead to a rupture of the disc or disc herniation of material into the surrounding tissue. This ruptured disc material when expanded out where it does not belong will cause pain. This pressing and expansion of a degenerating disc also creates chemical irritation to the nerves located near the disc.
There is no way to reverse the degenerative aging process that all discs experience. The best advice for everyone is to be careful to limit as much as possible the amount of spinal abuse that the discs receive in a lifetime. All impact and injury to the spine has consequences, even if they are not obvious at the time. Avoid activity that jars, excessively twists or impacts against the neck and lower lumbar spine.
Stay limber by using good stretching exercises and toned by following a good exercise program. Disc tissue receives necessary primarily through normal physiologic motion; if there is little spinal movement, there is little nutrition going into the disc.Exercise using both aerobic and resistive activities that are shown to be beneficial for spinal health. Exercise enhances spinal nutrition while a sedentary life may lead to accelerated. Eat well to supply all important nutrients.
Treatment of degenerative disc disease
Early treatment, initial care, of a degenerative disc disease in the neck or low back should always be conservative and non-surgical. Many people make a huge mistake by using aggressive and non-reversible surgery as their first response to a disc problem.
Initial treatment should first consist of ice and rest, with anti-inflammatory medication if absolutely needed. Next, care should soon include mild stretches and back exercises in the form of resumption of light activity that focus on increased spinal and abdominal muscle strength. If strengthening and conditioning exercises and anti-inflammatory medications are not helpful, a brace is often prescribed. A brace or support can be used during acute pain episodes, and later as a preventive measure during strenuous activities.
To successfully live with degenerative disc disease a patient must eventually learn prevention strategies:
- How to avoid placing frequent or large amounts of stress on the spine.
- How to lift properly.
- How to perform the necessary work of the day while still applying the least amount of spinal stress as possible.
- How to lift without injuring the low back.
- How to rotate the neck without aggravating it or causing a pinched nerve.
- All necessary measures to protect the thinning disc tissue.
If the patient does not respond well to conservative care, joint manipulation may be an appropriate additional therapy. Spinal manipulation will correct any spinal joint dysfunction that might exist in the area and be contributing to the overall disc problem.
If a patient does not respond well to a conservative course of care of two or three months for an acute pain episode in which the disc is involved, then surgical options might be considered. A spinal fusion which is designed to unit and stabilize the vertebrae together to prevent painful motion might be considered. Also, a fusion may or may not include removal of a portion of the offending disc to prevent irritation to the neighboring nerve structures by the disc.