DEGENERATIVE DISC DISEASE
The discs are like shock absorbers between the bones of the spine and are designed to help the back stay flexible while resisting terrific forces in many different planes of motion. Each disc has two parts:
A firm, tough outer layer, the anulus fibrosus. The outer portion of this layer contains nerves. If the disc tears in this area, it can become quite painful.
A soft, jellylike core, the nucleus pulposus. This part of the disc contains proteins that can cause the tissues they touch to become swollen and tender. If these proteins leak out to the nerves of the outer layer of the disc, they can cause a great deal of pain.
SPINAL DISC ANATOMY
The typical person with degenerative disc disease is active, otherwise healthy and in his or her 30s or 40s.
Common symptoms of this condition include:
Pain that is worse when sitting. While seated, the discs of the lower back have three times more load on them than when standing.
Pain that gets worse when bending, lifting or twisting.
Feeling better while walking or even running than while sitting or standing for long periods of time.
Feeling better changing positions often or lying down.
Periods of severe pain that come and go. These last from a few days to a few months before getting better. They can range from nagging pain to disabling pain. Pain can affect the low back, buttocks and thighs or the neck, depending on where the affected disc is, radiating to the arms and hands.
Numbness and tingling in the extremities.
Weakness in the leg muscles or foot drop, a possible sign of damage to the nerve root.
Several factors can cause discs to degenerate, including age. Specific factors include:
The drying out of the disc. When we are born, the disc is about 80 percent water. As we age, the disc dries out and doesn't absorb shocks as well.
Daily activities and sports, which cause tears in the outer core of the disc. By age 60, most people have some degree of disc degeneration. Not everyone at that age has back pain, however.
Injuries, which can cause swelling, soreness and instability. This can result in low back pain.
Pain from degenerative disc disease is caused by a combination of instability at the motion segment and inflammation from the degenerated discs. Both the instability and the inflammation have to be addressed for the back pain treatment to be effective.
The treatments for degenerative disc disease are either passive (done to the patient) or active (done by the patient). Usually, a combination of treatments is used to help control the symptoms. Passive treatments are rarely effective on their own—some active component, such as exercise, is almost always required.
Passive treatments for low back pain from degenerative disc disease may include:
Typical pain medications used to treat the low back pain include acetaminophen, NSAIDs, oral steroids, narcotic drugs, and muscle relaxants. Each type of medication has strengths, limitations, and risks, and the patient's particular low back problem and overall health will determine which pain reliever, if any, is indicated.
Manual manipulation by a chiropractor or other qualified health professional is thought to provide lower back pain relief by taking pressure off sensitive neurological tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and creating a series of chemical reactions in the body (such as endorphin release) that act as natural painkillers.
An epidural injection into the spine delivers steroids that can provide low back pain relief by decreasing inflammation in the painful area.
Transcutaneous Electrical Nerve Stimulators (TENS) devices deliver mild electrical stimulation that overrides the painful signals sent to the lower back.
For acute back pain in the low back, ultrasound may be used to warm the area, which in turn brings blood flow and healing nutrients to the area.
Therapeutic low back massage is thought to provide low back pain relief by improving blood flow, reducing muscle stiffness, increasing range of motion, and raising endorphin levels in the body.
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