What is degenerative disc disease?

What is degenerative disc disease?

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Degenerative disc disease (DDD) is a condition that refers to the gradual deterioration of the intervertebral discs in the spine, particularly the low lumbar segments (low back). Despite its name, it is not actually a disease but rather a natural part of the aging process. The intervertebral discs are located between the vertebrae and serve as shock absorbers, providing cushioning and flexibility to the spine. Injury or degeneration of the disc affects spinal mechanics in general. The force distribution through the entire segment is altered, causing abnormal forces on the spine and its supporting structures. Physical loading and repetitive spinal movements are responsible for mechanical “wear and tear” on the disc that may lead to degeneration.  

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Common symptoms of degenerative disc disease

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The degenerative changes associated with DDD can cause a range of symptoms, which may include:

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1. Back or neck pain: Degenerative disc disease is most likely to affect the lower lumbar spine (low back), but can affect the upper lumbar spine and cervical spine as well. It can lead to chronic or intermittent pain in the affected area of the spine and is aggravated by heavy physical activity or after a prolonged time in one position. The pain can be localized or may radiate to other parts of the body, such as the arms or legs.
2. Radicular pain: If a herniated disc or bone spur compresses a nerve root, it can result in radiating pain, numbness, tingling, or weakness that follows the path of the affected nerve. For example, in lumbar DDD, this can manifest as sciatica, where pain radiates down the buttocks and into the leg.
3. Loss of flexibility: Reduced disc height and changes in the spinal structures can limit the range of motion of the spine, leading to stiffness and a decreased ability to bend, twist, or perform certain activities.
4. Muscle weakness or instability: In some cases, DDD can affect the stability of the spine or put pressure on nerve roots, leading to muscle weakness, coordination problems, or difficulty maintaining balance.

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What causes degenerative disc disease?

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While degenerative disc disease is a natural part of aging, certain factors can contribute to its development or progression, including genetics, smoking, obesity, occupational hazards, and injuries to the spine. This degeneration can occur due to various factors, including:

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1. Loss of disc height: The discs lose water content and become less hydrated, causing a decrease in disc height. This can lead to a reduction in the space between the vertebrae and increased compressive force on the area which can affect the stability and alignment of the spine.
2. Disc bulging or herniation: With degeneration, the outer layer of the disc, known as the annulus fibrosus, may weaken or develop small tears. This can allow the gel-like inner material, called the nucleus pulposus, to protrude or herniate, potentially impinging on nearby nerves and causing pain.
3. Bone spurs: As the discs degenerate, the body may respond by forming bony outgrowths called osteophytes or bone spurs. These spurs can develop around the edges of the vertebrae and the intervertebral joints, potentially encroaching on nerve roots or the spinal canal.

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How can physical therapy help? 

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Physical therapy can play a significant role in managing and treating degenerative disc disease (DDD). While physical therapy cannot reverse the degenerative process, it can help alleviate pain, improve function, and enhance the individual's quality of life. Here are some ways in which physical therapy can help with degenerative disc disease:

1. 1. Pain management: Physical therapists use various techniques and modalities to manage pain associated with degenerative disc disease. These may include heat or cold therapy, ultrasound, electrical stimulation, or manual therapy techniques. Traction may also be prescribed to the patient, it has the benefit of widening the disc space that can help decrease pressure on the spine. They can also teach individuals self-management strategies for pain relief, such as proper body mechanics, postural education, and activity modifications.
2. Strengthening and stabilization exercises:  Physical therapists prescribe strengthening and stabilization exercises that target the extremities and spinal stabilizing muscles such as; back and core (abdominal) muscles. These exercises are used to improve muscle strength and performance as well as spinal control. 
3. Manual therapy: Manual therapy techniques, such as joint mobilization or spinal manipulation, may be used by physical therapists to reduce pain, improve joint mobility, and alleviate muscle tension associated with degenerative disc disease. These hands-on techniques can help relieve stiffness, improve spinal alignment, and reduce pressure on the affected discs.
4. Posture training: Physical therapists provide education on proper posture and body mechanics to minimize stress on the spine and discs. They teach individuals how to maintain good posture and spinal movements in pain-free ranges during daily activities, such as sitting, standing, lifting, and bending. Proper body mechanics can help reduce strain on the discs and surrounding structures, potentially minimizing pain and preventing further degeneration.
5. Aerobic exercises: One of the important components of the exercise program for patients with degenerative disc disease is aerobic exercises such as; walking, swimming, stationary bicycle and others. These exercises help to improve strength and overall endurance of the patient. 
6. Patient education: Physical therapists educate the patients about his or her condition, what to expect and the techniques in managing symptoms. They also teach safe movement patterns to protect the back and can assess an individual's work or home environment and provide recommendations for activity modification and ergonomic adjustments. This includes suggestions for proper lifting techniques, use of assistive devices, workstation setup, and ergonomic equipment to minimize stress on the spine and improve overall spinal health.
7. Functional training: Physical therapists focus on improving functional abilities affected by degenerative disc disease. Once the patient has learned spinal control and stabilization, and has developed adequate flexibility and strength for specific tasks, components of the tasks are incorporated into the exercise program.
8. Home exercise program: Physical therapists provide specialized home exercise programs that are specific on the patient's condition and overall function. It aims to reinforce the intervention and promote self-management.

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Physical therapists often work in collaboration with other healthcare professionals, such as physicians, orthopedic specialists, or pain management specialists, to provide comprehensive care for individuals with degenerative disc disease. They may consult and coordinate treatment plans to ensure the most effective and appropriate care.

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It's important to note that the specific treatment approach in physical therapy may vary based on the individual's condition, age, area affected, and symptoms. A physical therapist will conduct a thorough evaluation and design a treatment plan that addresses the individual's unique needs, focusing on pain management, functional improvement, and overall well-being.

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