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- Degenerative disc disease is almost universal.
It's essentially, what I like to call,
wear and tear on the spine.
The discs within the spine are..
how I describe it, like a jelly donut.
There's a jelly in the center and hard caritlage
rings around the outside.
These are the discs in between the bones.
These are the cushions, the shock absorbers.
This is where the deterioration first occurs.
Where we have drying of the discs,
narrowing of the spaces.
As the discs become more narrow,
the nerve holes, where these nerves exit,
become narrow.
And the central canal, which is where the spinal cord
and spinal nerves are, that becomes narrow as well.
The symptoms of degenerative disc disease,
or DDD as we call it,
can span just about any other cause of back pain.
You can have pure back pain in the center of the lower back,
which is typical of pain in the disc, in and of itself,
You can have pain radiating out along the belt-line,
which is typical of muscular pain
or joint-related pain, those structures will become painful
as the wear and tear occurs.
You'll have joint pain in the facet, or facet, or z-joints
of the spine as the muscles try to splint
and get tight to try to stabilize the spine,
you'll get muscle pain, muscle spasms.
You can also, with narrowing of the spaces around the nerve,
because of collapse of the spine with the wear and tear,
you can also have nerve pain.
Which then radiates or can radiate down
down the leg, even past the knee
towards the foot or the ankle.
You can also have positional discomforts.
Things like, "It hurts me more when I stand and walk,"
versus, "It hurts me more when I sit,"
"It hurts me more getting up out of the chair
"but once I'm up and moving, it's a bit better."
Essentially any pain that anyone can have in the lower back
could be related to degenerative disc disease.
So as part of my usual examination
after watching the patient walk into the room,
and see how they walk, see how they move,
see how they do things like sit on the chair,
stand from the chair, get on and off the table,
we do a basic neurologic examination to make sure
that the nerves are working properly.
And that's things like strength, sensation, and reflexes.
The most important point, or part of the examination,
is actually the history taking.
That's when the doctor should just listen
and hear the story and I believe
that if you allow the patient to tell their story
the majority of patients will actually tell you what's wrong
and you can get that information through their history
as to whether or not you think it may be more of a
disc pain, or a nerve pain, or a joint pain.
We then test motion of the spine
in forward bending and bending backwards
and side bending and that can give us an indication
as to whether or not it's more likely a disc pain
or a joint paint, or a muscle pain.
And then once we get in to things like physical therapy,
we start to test people more in the realm of
strength and functional ability.
Imaging studies are both crucial and not important
all in the same time.
One of the biggest problems that people come to me
and my partners with is that they're labeled
because of an imaging study.
If you take the population over forty, fifty years old
off the street, and put everyone through an MRI
you're going to find degenerative disc disease
on nearly everyone but that certainly doesn't mean
that it has to hurt, doesn't mean that it doesn't.
So the imaging study really should be used
as a secondary means to take a look
at what you are thinking is going on.
Treatment options certainly very
and cover the entire spectrum of lower back care.
The reason is is because, again,
the main question is what is the pain generator,
what's the source of the pain.
That DDD label is not a pain source.
If someone's suffering from disc pain or joint pain
or muscle pain, and those treatments may vary.
Typically we use some ice,
some anti-inflammatory medications,
some pain relievers, some muscle relaxers
and those are designed to treat the symptoms.
And then we'll begin things like physical therapy
or chiropractic care.
Physical therapy is a great way to gain flexibility,
it's a great way to provide better posture,
make sure the pelvis is working properly,
it's tipped properly, everything is angled properly.
Range of motion is very important to make sure
you're not restricting the limbs or the pelvis
or the spine in terms of its motion.
And then strengthen those areas
in the proper position to more properly stabilize the spine.
Chiropractic can be very helpful
in manipulating the spine, in repositioning the bones,
in loosening the restrictions of the joints
in the back of the spine, to gain better mobility
as well as a great deal of muscular work
that the chiropractors can perform to loosen
the muscular restrictions in that area as well.
Then based on imaging studies and possibly
electrical testing, we can move into the realm of
interventional treatment, or injection treatments,
which can be epidural steroid injections
which are anti-inflammatory injections
performed over a painful nerve or and inflamed nerve.
We can also do several different procedures including
both steroid injections into the joints of the spine,
as well as nerve blocks to the nerves
that supply the painful sensations of the joint
to rid someone of the joint pain of degenerative disc
or degenerative spine disorder.
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