Last post we covered the basic anatomy and function of the lumbar disc and how it causes pain. Now I will go over the condition degenerative disc disease (DDD). This is quite a prevalent condition that is usually associated with degenerative joint disease aka osteoarthritis (OA) of the lumbar spine.
So how does the disc break down over time?
This can happen in two main ways.
1)There is a poor blood supply available to the disc as a whole, especially in the nucleus pulposus. The nucleus relies on much less efficient energy delivery systems known as diffusion and bulk flow. This results in a poor ability to repair damaged disc tissue. Unlike bone injuries, which recover through cell remodeling, the disc lays down scar tissue. Scar tissue is much weaker than the original collagen and thus can lead to changes in disc shape/narrowing. [i]
2)Another factor is that the disc loses water content as we age. This places more compressive strain on the outer fibers of the disc. Review last post for more on disc function.
Whenever there is a weakness/injury, the body will take necessary action to compensate. In this case, there will now be increased pressure placed on the posterior low back joints. As a result the joints become larger and irregular to support the added compression. If you look at this on an X-ray, it would be called arthritis.
Now there are numerous patients that are told they have “disc disease” and low back arthritis, which can lead to the perception that they are condemned to lifetime of irreversible pain/suffering. DDD and lumbar osteoarthritis can be painful conditions in some individuals but it is also commonly found in people with no symptoms at all. [ii] [iii]
Signs of osteoarthritis and DDD are really no different than getting wrinkles or grey hair; its just another part of the aging process.
The first line of therapy for any patient with DDD or OA is reassurance. This will break the belief that they have a debilitating disease. Next, it is up to your chiropractor or physiotherapist will thoroughly assess you determine the true source of pain.
Next post, we take a break from low back pain and focus on another common injury: ankle sprains.
Dr. Mike Rumeo is chiropractor with a passion for improving the health of his community and pain management. He primarily utilizes chiropractic, medical acupuncture and rehabilitation to help his patients. He is the owner of the Oakville Optihealth Clinic, a multidisciplinary clinic located at Fourth Line and South Service Rd W, in Oavkville ON. To contact Dr. Rumeo, please email him at firstname.lastname@example.org or call at 905.465.0202.
[i] Adams MA & Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine 2006; 31(18): 2151-2161.
[ii] Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73. PubMed PMID: 8208267.
[iii] Teraguchi M, Yoshimura N, Hashizume H, Muraki S, Yamada H, Oka H, Minamide A, Nakagawa H, Ishimoto Y, Nagata K, Kagotani R, Tanaka S, Kawaguchi H, Nakamura K, Akune T, Yoshida M. The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama Spine Study. Spine J. 2014 Nov 27. pii: S1529-9430(14)01758-6. doi: 10.1016/j.spinee.2014.11.012. [Epub ahead of print] PubMed PMID: 25433277.