What’s the Best Treatment for Degenerative Disc Disease?

what is ddd?
Sad but true

“What’s degenerative Disc disease mean to you?”

I’ve asked this questions to 1000’s of patients with low back pain. It is the most common diagnosis I encounter and the most understood. The best treatment for degenerative disc disease depends on several factors. It doesn’t help that the diagnosis

  • Sounds scary
  • Is handed out like candy
  • Often misunderstood

Let’s clear up the confusion and try to remove the fear associated with it.

🚨SPOILER ALERT🚨

just kidding!!

You may not believe this, but what I’m about to say is GREAT news.

There is NO cure for this degenerative disc disease. This is because IT IS NOT A DISEASE.

See? GREAT news! I guess I just cured you?

WHAT is Degenerative Disc Disease?

Degenerative disc disease (DDD) is a label for the degenerative changes that occur in the spine, and typically it is referring to the discs. Everyone (EVERYONE!) develops some level of degenerative changes as they get older.

It is possible to have above average changes and no pain, or, below average changes and intense pain. I see it all the time.

The reason is complex, but it has to do with the nature of pain. We can get into that later.

Other findings associated with DDD are:

  • osteophytes (bone spurs)
  • facet joint arthropathy (arthritic changes to the joint)
  • foraminal narrowing – The foramen is the space nerves pass through from the spinal cord to the rest of the body. The narrowing is likely because of osteophytes and facet joint arthropathy.

You can have these findings and zero pain. Or none of these findings and have intense pain.

Why is the diagnosis and treatment of degenerative disc disease confusing?

healthy disc anatomy
Figure 1 components of the spine

Knowing the components of the spine is a great place to start to understand. In Figure 1 you can see the NUCLEUS, the fluid-filled center of the disc. The ANNULUS Is the outer ring. The NERVE ROOTS exit the spinal cord to the body through the FORAMEN (not labeled).

anatomy of a herniated disc as well as common findings in ddd
Figure 2 Fissures and Herniated Disc (purple arrow)

Now we can compare that to the PURPOSELY exaggerated cartoon drawing of a degenerated disc. Notice the fissures that form in the annulus. The fissures are the “degeneration,” and they are the normal process of aging likely caused by compression (gravity). 

Over time, small fissures can combine and become big fissures, and those fissures can break through the edge of the annulus.

Disc material can travel through those fissures, which would be a HERNIATED DISC. A herniated disc can develop slowly over time or quickly because of some type of loading injury.

Why Does My Back Hurt?

The center of the disc and inner edges of the annulus do not have pain receptors, only the outer edges of the annulus. That means you won’t feel pain unless the outer edges of the annulus are affected. 

The biggest issue with the spine is that there is not much room back there for a bunch of extra stuff without irritating the nerve. Things considered “extra” stuff could be:

  1. Inflammation – damage to the annulus will create an inflammatory response, just like it does with any damaged tissue in the body. Inflammation increases pain sensitivity – things hurt more. This is the reason a steroid dose pack helps immediately after a disc injury. It doesn’t “heal” anything, it just reduces the stuff (inflammation) that makes your pain increased.
  2. Herniated disc material – depending on where the herniation is, the material can make contact with the nerve root. We think this heals over time.
  3. Osteophytes (bone spurs) and/or face joint arthropathy (rthritic changes) – more things that can encroach on the nerve root, or just limit how much you can move.

Compression of the nerve root is called RADICULOPATHY. You may experience:

  • pain
  • weakness
  • numbness and tingling that goes into the legs (back) or arms (neck).

You can see our favorite exercises for radiculopathy here.

MYELOPATHY is a more servere diagnosis that involved compression of the spinal cord. It is less common BUT considered a MEDICAL EMERGENCY.

Is my back pain a medical emergency? Find out >>> here

The Best Treatment, Prognosis and what you can do now with degenerative disc disease

So DDD is a weird diagnosis because 1) it’s a commentary on the state of things and 2) there is no cure, but that’s okay, since it isn’t really a disease.  

You pain and symptoms are largely related to whatever deficits you’ve picked up along the way. Most of the treatments are aimed at those deficits and focus decreasing your pain, improving your range of motion, and improving your strength. How long it takes to improve your pain and deficits depends on what the treatment is focusing on.

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