“What does generative Disc disease mean to you?”
I’ve evaluated and treated 1000’s of people with low back pain that were diagnosed with Degenerative Disc Disease (DDD), and this is the first question I typically ask. The answers I get are all over the place because this diagnosis
- Sounds scary
- Is handed out like candy
- Often misunderstood
I’m going to clear up the confusion of the diagnosis and try to remove the fear associated with it.
🚨SPOILER ALERT🚨
This is hard to believe 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?
Well then 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 – some more, some less, than what is considered average.
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. There are typically other findings associated with DDD, like 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.
LET ME REPEAT, you can have these findings and zero pain. Or none of these findings and have intense pain.
Why is the diagnosis of degenerative disc disease confusing?
A good place to start in order to understand this diagnosis is to understand the components of the spine. In Figure 1 you can see the NUCLEUS, the fluid-filled center of the disc. The outer ring is called the ANNULUS. The NERVE ROOTS exit the spinal cord to the body through the FORAMEN (not labeled).
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. Additionally, the 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?
It is thought there are no “pain” receptors in the center of the disc as well as the inner edges of the annulus, only in the outer edges. So 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:
- 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. That is why a bruise hurts, it is inflamed making it more sensitive. That’s why people get prescribed steroid dose packs after an acute disc injury and their pain is reduced. It doesn’t “heal” anything, it just reduces the stuff (inflammation) that makes your pain increased.
- Herniated disc material – depending on where the herniation is, the material can make contact with the nerve root. It is thought that discs can reabsorb the material, thus “healing.”
- Osteophytes (bone spurs) and/or face joint arthropathy (arthritic changes) – more things that can encroach on the nerve root, or just limit how much you can move.
When that space is compromised and things compress or irritate the nerve root, that is likely when you will get diagnosed with RADICULOPATHY. With that, you can experience pain, weakness, and/or numbness and tingling that goes into the legs (back) or arms (neck). You can see our favorite exercises for radiculopathy here.
A more severe diagnosis, but way (way, way) less common, is MYELOPATHY, which actually involves compression of the spinal cord. This is actually a MEDICAL EMERGENCY but fortunately it’s super uncommon.
My back hurts, do I need the emergency room? Find out >>> here
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.