Lumbar degenerative disc disease
Degenerative disc disease refers to a syndrome in which a compromised disc causes low back pain. Lumbar degenerative disc disease usually starts with a torsional (twisting) injury to the lower back, such as when a person rotates to put something on a shelf or swing a golf club. However, the pain is also frequently caused by simple wear and tear on the spine.
Despite its rather dramatic label, degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, after a patient reaches 60, some level of disc degeneration is deemed to be a normal finding, not the exception.
Lumbar degenerative disc disease pain and symptoms
Most patients with lumbar degenerative disc disease will experience low-grade continuous but tolerable pain that will occasionally flare (intensify) for a few days or more. Pain symptoms can vary, but generally are:
- Centered on the lower back, although it can radiate to the hips and legs
- Frequently worse when sitting, when the discs experience a heavier load than when patients are standing, walking or even laying down
- Exacerbated by certain movements, particularly bending, twisting or lifting
The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of two sources:
- Inflammation, as the proteins in the disc space irritate the surrounding nerves, and/or
- Abnormal micro-motion instability, when the outer rings of the disc - the annulus fibrous – are worn down and cannot absorb stress on the spine effectively, resulting in movement along the vertebral segment
Excessive micro-motion, combined with the inflammatory proteins, can produce ongoing low back pain
Fortunately, over time the pain from lumbar degenerative disc disease usually decreases, rather than becoming progressively worse. This is because a fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position, eliminating the micro-motion that generates the pain.
Lumbar degenerative disc disease diagnosis
Following a review of the patient’s history and a physical examination, a formal diagnosis of lumbar degenerative disc disease can be confirmed with x-rays, ct scan, or magnetic resonance imaging (MRI). Findings that are closely linked to a painful disc include disc space collapse of greater than 50% and cartilaginous endplate erosion.
Lumber degenerative disc disease treatment
For most people, degenerative disc disease can be successfully treated with conservative (meaning non-surgical) care consisting of exercise, chiropractic, massage and ice and heat applications. Medication can also control inflammation and pain, however the effects that NSAIDS have on stomach linings and kidneys should make a person think twice for relying on medication as a long term treatment of degenerative disc disease. Surgery is only considered when patients have not achieved relief from conservative care and/or are significantly constrained in performing everyday activities.
Non-surgical treatment for degenerative disc disease
At Holmes Spine & Sport Chiropractic we provide a number of conservative treatments under one roof to treat your lumbar disc degeneration. We also work with your family physician or orthopedic surgeon to assist in getting you any medications or consultations you may need.
- Chiropractic manipulation can relieve low back pain by taking pressure off sensitive nerves or tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and, like more active exercise, promoting the release of endorphins within the body to act as natural painkillers
- Applying heat to stiff muscles or joints to increase flexibility and range of motion, or using ice packs to cool down sore muscles or numb the area where painful flares are concentrated.
- Medications such as non-steroidal anti-inflammatories may be used to manage intense pain episodes on a short-term basis, and some patients may benefit from an epidural steroid injection. Not all medications are right for all patients, and patients will need to discuss side effects and possible factors that would preclude taking them with their physician.
- An exercise program is essential to relieving the pain of lumbar degenerative disc disease and should have several components, including:
- Hamstring stretching, since tightness in these muscles can increase the stress on the back and the pain caused by a degenerative disc
- A strengthening exercise program, such as Dynamic Lumbar Stabilization exercises, where patients are taught to find their ‘natural spine’, the position in which they feel most comfortable, and to maintain that position
- Low-impact aerobic conditioning (such as walking, swimming, biking) to ensure adequate flow of nutrients and blood to spine structures, and relieve pressure on the discs
- Traction Decompression Therapy and relieve pressure on sensitive nerve structures