Degenerative disc disease: Managing this common cause of back pain

As we age, the discs in our spine can degenerate, causing chronic pain and discomfort in the back and neck that can significantly impact daily life. Understanding what degenerative disc disease (DDD) is, its symptoms, causes, and the available treatment options can help you manage this common condition and improve your quality of life.

What is degenerative disc disease?

Degenerative disc disease is a condition that affects the discs between the vertebrae in your spine. Each disc has a gelatinous center and a tougher outer covering. These discs act like cushions, absorbing shock and allowing flexibility and movement in your back. Over time, the discs can degenerate. This can lead to pain and discomfort in your back and neck from the loss of protective cushioning.

DDD is a natural part of aging. It is not actually a "disease," but rather a condition that can cause symptoms if the discs deteriorate significantly. When discs are damaged, the inner part can push out and press on the spinal cord or nerve. This is known as a herniated or "slipped" disc, and it may cause weakness. The disc can also become so worn out that the vertebrae start to rub together.

DDD is one of the most common causes of back pain, especially in older adults.

Common symptoms of degenerative disc disease

The symptoms of degenerative disc disease can vary widely from person to person. Some people may experience severe pain, while others may have little to no discomfort. Symptoms usually arise as the condition progresses. In addition to the back, persistent pain can also occur in the buttocks, thighs, or neck, depending on which discs are affected. Other common symptoms include:

• Sharp pain: Sudden, intense pain that can be triggered by movements like bending or twisting. Over 90% of herniated discs happen in a region of the lower back called the lumbar spine. Pinched nerves in this area cause pain to spread down the back of the leg and the top of the foot. But shooting pain can also occur in the arms from degenerated discs in the neck.
• Pain that worsens with activity: Physical activities, especially those that involve lifting or twisting, can make the pain worse. Even light exercise such as walking can cause pain if the disc has degenerated enough.
• Numbness, tingling, and/or weakness: If the degenerated disc presses on nearby nerves, it can cause numbness, tingling, weakness, or a combination of these in the arms (from pinched nerves in the neck) or legs (from pinched nerves in the back).

Lying down can often provide relief from pain because it reduces the stress on the spine.

What can cause degenerative disc disease?

Degenerative disc disease is primarily caused by the natural aging process. As we get older, the discs in our spine lose their water and protein content, making them less flexible and more prone to wear and tear. However, several factors can increase the risk of developing DDD or cause worsening symptoms. These include:

• Genetics: A family history of degenerative disc disease can make you more susceptible to the condition.
• Injury: A back or neck injury can damage the discs and lead to future development of DDD.
• Repetitive stress: Jobs or activities that involve repetitive lifting, bending, or twisting can put extra stress on the discs. With time, this wear and tear can worsen disc degeneration.
• Obesity: Excess body weight puts additional pressure on the spine, accelerating disc degeneration.

Managing symptoms of degenerative disc disease

While there is no cure for degenerative disc disease, there are several ways to manage the symptoms and improve your quality of life.

Physical therapy and lifestyle changes are essential parts of treatment and prevention. Physical therapy can help strengthen the muscles that support your spine, improving flexibility and helping to reduce pain. A physical therapist can design a personalized program, typically with emphasis on stretching and strengthening exercises, to address your specific needs.

Maintaining a healthy weight and avoiding activities that put excessive strain on your back can also help manage the symptoms of DDD. Regular exercise, especially low-impact activities like walking or swimming, can also help.

For relief of pain and discomfort, other treatment options include:

• Medications: Over-the-counter pain relievers like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol) can help reduce pain and inflammation. In some cases, doctors may prescribe stronger medications or muscle relaxants.
• Hot and cold therapy: Applying heat or cold packs to the affected area can provide relief from pain. Heat helps relax muscles and improve blood flow, while cold can reduce inflammation and numb the painful area.
• Alternative therapies: Some people find relief through alternative treatments like acupuncture, chiropractic care, or massage therapy. Discuss these options with your doctor to ensure they are safe and appropriate for your condition.

Emerging treatment options such as growth factor and stem cell injections are also being actively researched.

Surgical treatments

In most cases, degenerative disc disease can be treated without surgery. However, in severe cases when conservative treatments are not effective, surgery may be an option. If symptoms due to disc degeneration worsen and affect daily activities, surgery can relieve pressure and stabilize the spine. The most common surgical options include:

• Spinal fusion: In this procedure, two or more vertebrae are permanently connected to eliminate movement between them. This can help reduce pain but may limit flexibility.
• Artificial disc replacement: This surgery involves replacing the damaged disc with an artificial one to maintain motion in the spine. It is a newer procedure and not suitable for everyone.
• Laminectomy: A laminectomy involves removing part of the vertebra to relieve pressure on the spinal cord or nerves. This can help reduce pain and improve mobility.
• Discectomy: A discectomy is the removal of the damaged portion of a disc that is pressing on a nerve. It can provide significant pain relief, and is often done as a minimally invasive procedure.