There are times when young people in their thirties or forties come to our clinic with complaints that they are suffering from chronic lower back pain which becomes unbearable now and then! Sitting for a long time or carrying heavy loads seem to increase the pain. They are generally diagnosed as suffering from Degenerative Disc Disease commonly known as DDD.
Degeneration of inter-vertebral disc can cause severe pain and affect the normal life of the patient. As people grow older disc degeneration is a natural change though the degree of degeneration may vary from person to person. But the symptoms of Degenerative Disc Disease do not always ‘show up’ in all the patients and the nature and severity also vary!
After being diagnosed with DDD, the patients usually come up with some common questions.
The questions are mainly regarding whether:
• it will worsen with age
• they can become partially or totally disabled
• it will spread to other parts of the spine or to other parts of the body
• normal activities of life will become restricted
• It can cause permanent damage.
However, you’d be assured to know that the pain is not strictly degenerative. Although the disc degeneration may progress with age, the low back pain does not necessarily increase with it. Moreover, it cannot be labeled as a ‘disease’. Degeneration is a natural condition that at times can result in pain due to a damaged disc.
Causes of Degenerative Disc Disease
The lumbar disc in the spine is a unique structure that is strong enough to resist forces from different planes of motion but itself is very flexible. It acts as the shock absorber between the vertebral bodies. The lumbar disc is made of
i. Annulus fibrosus—the disc’s firm, tough outer layer
ii. Nucleus pulposus—the jelly-like inner disc material
Nerves of the disc space generally penetrate only up to the outer portion of annulus fibrosus. But for some people the nerve endings go deep into the annulus fibrosus making the discs more vulnerable to pain. After some injury or trauma often some discs get inflated causing severe pain. The healing process that is involved in the repair of injury to the outer annulus creates irritation of the resultant scar tissue, resulting in pain of the disc.
The nucleus pulposus contains jelly-like inflammatory proteins. If this material comes in contact with a nerve root, the nerves are inflamed causing pain in the disc. Similarly, if the inflammatory proteins leak out to the outer layer and come in contact with the pain fibers, they create a lot of low back pain.
The patients diagnosed with Degenerative Disc Disease, are generally young and active. In most cases the pain is not severe or continuous. It is more related to activity. It may be felt while sitting, standing in the same position for a long time, lifting heavy things, bending or twisting. The pain may flare up at times and then subside gradually. The common symptoms of DDD are:
• Pain aggravates in sitting condition as in this position the lumbar discs carry three times more load than standing.
• Bending, twisting and lifting heavy things increase the pain.
• Lying down is the best position to relieve pain as it releases the stress on the disc.
• Changing the positions frequently also gives relief to the pain.
• After sitting or standing for a long time patients will feel better if they walk or even run.
• The low back pain may spread to the hips.
• While walking pain may be felt in the thighs or buttocks.
• Intermittent tingling sensation or weakness in the knees may be present
Types of Pain
i. Chronic low back pain.
ii. Intermittent severe pain with muscle spasms.
The patients report the chronic low back pain is still tolerable, but it is the sporadic severe pain with muscle spasms that make them feel ‘immobilized’. They are also worried whether this severe pain indicates permanent tissue damage. Like them you may want to know the cause of this intermittent severe pain. Though the reason of the severe pain cannot always be specified, you’ll feel better to know that the intensity of pain is not equivalent and is unrelated to tissue damage. It may be due to the abnormal micro-motion in the degenerated disc that instigates the inflammation. To stabilize the spine and normalize the micro-motion the body reacts with muscle spasms causing severe disc pain.
The severe pain generally lasts from a few days to a few months. The baseline chronic pain differs in its severity from person to person. It can range from being irritating to severe disabling pain, though this disabling pain is very rare.
Degenerative Disc Disease is generally treated with a combination of medication and physical therapy and exercise. The chronic pain and the intermittent flares, both can be controlled through them.
Modifying Your Activities
The first step of treatment is to control the activities that can increase the pain. You should avoid activities like lifting heavy objects, playing sports that require twisting of back etc. Check out the correct ergonomic postures for your condition, like how to lift heavy objects and the correct sleep posture that reduces pressure on the low back. You are also advised to seat in proper office chairs at your workplace.
Common Non-surgical Treatment
• Exercise regularly to get relief from the pain. Your exercise program should include different aspects.
- Back strengthening exercise such as Dynamic Lumbar Stabilization exercise to find out the most comfortable position for your spine and maintain that position.
- Hamstring stretching
- Low-impact aerobic conditioning like walking, biking or swimming so that the adequate flow of blood and nutrients reach the spine and relieve pressure on the discs.
• Applying heat increases flexibility to stiff muscles and joints.
• Applying ice packs numb the painful flares and sooth the muscles.
• Chiropractic treatment can also provide relief from low back pain. The different ways are by restoring proper blood flow, reducing muscle tension, taking pressure off sensitive nerves or tissues, ensuring the release of endorphins in the body which act as natural pain-killers.
• Medications include non-steroidal anti-inflammatory and pain relievers that enable the patients to continue their regular activities. The intense pain can be reduced by going for prescribed oral steroids, narcotic pain relievers and muscle relaxants for temporary use and epidural steroid injection may also be prescribed after discussing the side effects with the patients.
If you do not get relief even after six months of treatment, and your regular activities get restrained due to pain, then surgery may be recommended. If the numb feeling and the weakness of the legs persist making it difficult to stand or walk, and all medication and physical therapy fails, surgery may be the last option which is most often spinal fusion.
In most cases, doctors try to avoid the artificial disc replacement surgery and try to give relief to the patients by regular exercise or medicines. Rehabilitation is the best way to start to get relief from back pain. And it is assured to the patients of Degenerative Disc Disease that they will not suffer from any permanent damage and in most cases the pain gradually subsides and becomes non-existent. If you’re one amongst them then now you know much better about how to address your problem than ‘just take it lying down’ both literally and figuratively!