As many as 80% of the population in the United States will experience back pain at least once in their life. Even though a large number will have spine pain it rarely needs surgery. Conservative care, like physical therapy, gets the same, if not better, results that surgery most of the time. Degenerative disk disease is a common reason for someone to experience back pain. Degenerative disk disease is a natural process and is happening in everyone to a certain degree. This process can happen anywhere in the spine, but is most common in the low back and neck. Degenerative disk disease is often referred to as a type of osteoarthritis of the spine.
What Everybody Ought to Know About Degenerative Disk Disease
Your spine is made up of 33 small bones called vertebrae. These vertebrae are stacked vertically and divided into three regions. Between each of the vertebrae is a disk. These disks are called “intervertebral disks” and are made up of rubbery type cartilage. These “intervertebral disks” allow for shock absorption and better movement of the spine.
The disk can is divided into two different parts. The outer ring is called the “annulus”. Filling in the middle is a gelatin like substance called the “nucleus”. The younger you are the more your disks are filled with gelatin. Up until about the age of 30 your disks are mostly gelatin. Part of the natural aging process after 30 causes you to begin decreasing the amount of gelatin.
Sometimes with injury or excessive wear and tear you can speed up the aging process of your spine. As the gelatin decreases in amount the height of the disk, and distance between vertebrae decreases. Over time the disk will become flatter and less flexible.
Sometimes in response to the decease in disk size bone spurs form. Bone spurs can make the spine less mobile and more stiff. If your disks become so flat that vertebrae begin to rub against each other, pain and inflammation may result. With decreased space between vertebrae nerves may also become irritated or compressed.
Degeneration of the disks can be localized to a specific disk or take place throughout the spine. Disk degeneration is a natural process. Almost every adult will have some sign of degenerative disk if given an x-ray or MRI. Disk degeneration does not always lead to pain and discomfort.
You are more likely to develop Degenerative disk disease if you:
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Smoke
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Are overweight
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Do heavy physical work
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Don’t get very much exercise
Common Signs of Degenerative Disk Disease
It is very possible that you might have degenerative disk disease and have no pain at all. There are several different ways that someone with degenerative disk disease can present. Usually if you are having pain that is caused from degenerative disk disease it can range from mild discomfort to intense pain.
1. A degenerative disk in the neck can cause pain in the arm, shoulder,or neck
2. A degenerative disk in the low back might cause pain in the back, buttocks, or legs
If you are experiencing pain due to degenerative disk disease it is often made worse by sitting, bending, and reaching. Your pain and discomfort may be worse immediately after waking up. You may also experience pain if you are in the same position for an extended period of time.
In very severe cases of degenerative disk disease can cause increased pressure on nerves leaving the spinal cord. This increased pressure can lead to numbness, tingling, and even weakness in the arms or legs.
If you are reading this and have degenerative disk disease do not be worried. Conservative treatments, such as physical therapy, have been proven to be effective in a majority of cases. Treatments focused on controlling pain and improving function have very good success rates.
How Is It Diagnosed?
If you feel that you are having pain or discomfort seeing a physical therapist first can help. When you see your physical therapist they will perform a through physical evaluation. The physical evaluation should include a review of your medical history. The medical history review will include both a written questionnaire as well a face to face conversation. Your therapist will also ask specific questions to help determine your dysfunction. In screening for degenerative disk disease your therapist might perform the following:
1. Discuss the location and behavior of your weakness, pain, and other difficulties
2. Have you to fill out a body diagram to show specific areas that are bothering you
3. Test muscle strength and sensation to determine if your nerves are involved
4. Observe how you move and perform a variety of activities and movements
5. Measure the range of motion of the body regions you are having problems with
6. Determine the mobility of the joints and muscles in your spine with hands on techniques
Based on the results of your examination your therapist will determine the severity of your complaints. In specific situations imaging such as x-ray may need to be performed. Only in severe cases are x-rays needed.
Your physical therapist works closely with other healthcare providers. If needed your therapist will refer you to another healthcare provider to make sure an accurate diagnosis is made.
Following you evaluation your therapist will let you know what is going on with your case. If they feel that you have degenerative disk disease with no major health concerns, you can begin therapy immediately.
If you you feel you have degenerative disk disease do not be afraid. Conservative treatments, such as physical therapy, have been proven to be effective in a majority of cases. Treatments focused on controlling pain and improving function have very good success rates. When compared to surgery physical therapy is more effective and safer.
Treat Degenerative Disk Disease like a physical therapist
The goal of all physical therapists is to improve your daily function and activities. Your physical therapist will create a plan with you based on the findings of your evaluation and your goals. Your plan of care will consist of specific movements and exercises.
Relieve Pain and Increase Movement
Part of your plan of care will include:
1. Flexibility and stretching exercises designed to improve mobility. These exercises will target the spine as well as the surrounding joints and muscles. Improvements in joint and muscle mobility are often a key to pain relief.
2. Strengthening of the trunk as well as the joints and muscles around the spine. The stronger the muscles and joint are around the spine the less stress there will be on the spine itself.
3. Aerobic exercise can improve several aspects that are important in managing disk degeneration. Aerobic exercise can decrease pain, promote healthy body weight, and improve overall mobility.
An interesting note, the more exercise you can handle the quicker your recovery. Research has shown that the more exercise you are able to perform the sooner you will get rid of your pain.
There are several other treatment options that your physical therapist might consider:
1. Hands on (manual) therapy can improve your joint mobility as well as decrease muscle tightness
2. Education about specific movements and posture. Often small changes in how you sit, stand, sleep, bend, and lift can drastically improve pain and function.
3. Special pain treatments such as ice, electrical stimulation, or traction to relieve pain.
You and your therapist should be able to manage and decrease your pain within several visits. Once you have limited pain it is still important that you continue with you full plan of care. People often don’t continue to do the exercises and stretches that relieved their pain and have recurrences.
Can this Injury or Condition be Prevented?
Degenerative disk disease is a natural part of aging, just like gray hair and balding. While getting gray hair or balding are not desirable they aren’t painful either. Currently there is no way to prevent disk degeneration. While there is no way to prevent it you can make choices that will lessen it impact. Most physical therapy clinics offer free consultations or educational seminars. If you think that you are at risk of disk degeneration you should contact your physical therapist.
If you are currently dealing with disk degeneration your physical therapist can help you create a fitness program. There are some general exercise principles that should be applied. For instance:
1. Exercising in a pool can allow you to exercise with minimal stress on joints.
2. Exercises that involve twisting and bending may not be appropriate for everyone.
3. Weight training exercises are very important, but need to be performed with correct form.
Real Life Experiences
Jim is a 52-year-old construction worker who has been diagnosed with Degenerative Disk Disease. As a construction worker Jim has had near constant aches and pains throughout his body. He has back pain that has been on and of for years. This episode of back pain is different though. This is the first time that his pain has been bad enough that he is seeking help.
A neighbor of Jim’s recommended that he go to physical therapy. She had recently had back pain that was treated at physical therapy.
Jim’s pain began in his low back but the longer he put off getting help the worse it got. By the time Jim began physical therapy his pain was spreading down the back of his thigh and into his knee. Jim had the worst pain when he was sitting and bending. His pain progressed to the point that he was only able to sit for about 10 minutes be fore he began having pain in both his back and leg.
Due to the physical nature of Jim’s work he did not take part in regular purposeful exercise. Jim is about 20 pound overweight.
On the first day of physical therapy Jim is taken through a thoughrough evaluation. He is asked questions to help determine his expectations, goals, lifestyle and health. Based on his conversation a hands on examination is performed to determine the severity of his condition. Jim’s strength and mobility are tested.
During Jim’s first treatment session:
1. He is given an explanation for some of the reasons for his problem. He also discusses the importance of special exercises to relieve his pain
2. Jim is shown simple changes to help take stress off his back as he is performing his daily activities.
3. Jim is given hands on therapy that decreases pain to the point where it is unnoticeable.
4. Jim is given 2 specific exercises to perform on his own to maintain his decreased pain for as long as possible.
Jim was diligent at following all the advice that he was given. After three weeks Jim reports he is now pain free and is able to perform all his normal daily activities. Over those three weeks Jim did have some bad days, but he made small progress as he continued to follow his plan. Jim was very pleased with his progress and committed to perform several minutes of specific exercise a day. At Jim’s 6 week follow up he was continuing to have no problems due his continued exercise program on his own.
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
Ben Toolson Physical Therapy 