My favorite professor in PT school used to say, “We wrinkle on the outside, and we wrinkle on the inside too.”
Low back pain is the most common health problem in the world, said to affect up to 85% of all people at some point during their life. Low back pain costs the world billions each year in healthcare costs. In the clinic, “degenerative disc disease” is a very common diagnosis I see. However it is rarely understood by the patient. I often have folks come into the clinic and say, “My doctor told me I have degenerative disc disease, my life is over.” Folks are often scared to move and believe they can no longer lead active lives. But this isn’t true! The problem is in how we educate our patients and how we explain what the diagnosis means. Using big scary words like “degenerative disc disease” and then not providing any additional information leads people to believe they are broken and beyond help. I want to debunk this and educate you on what it truly means for your life and activity level.
What is degenerative disc disease?
Degenerative disc disease (DDD) is the wearing down of the intervertebral discs or cartilage in your spine. Discs are normally composed of 80% water, and over time as we age this amount decreases. This equates to a thinner disc which reduces available spinal motion and in severe cases can encroach on nerves. However the process of discs wearing down is a normal aging process and almost all adults over the age of 60 have some amount of degeneration. While this degeneration can cause pain for some, many people have little to no pain, and often don’t even know they have this diagnosis until getting an XRAY or MRI. So why do some people with this diagnosis have pain, while others don’t?
Is DDD really the cause of your symptoms?
First we need to think about the type of injury/history of the symptoms. Is your pain brand new after a recent injury? Or has your pain been progressively worsening over the years? Disc degeneration doesn’t happen overnight. So if you woke up one day with a new pain in your back, just because imaging shows disc degeneration does not mean this is the cause of your symptoms. Many other structures can contribute to pain, including muscles, tendons, internal organs, etc, not only the spine.
Walking, running, and strengthening can improve symptoms
Second, even if you are in the category of having progressively worsening pain over the years, this does not mean you cannot have symptom improvement and be active. Studies show that lifestyle factors including obesity, sedentariness, and tobacco use contribute to more pain. Vice versa, strength training, cardiovascular exercise, and stretching can all contribute to symptom improvement. Rhythmic loading activities like walking and running actually help to nourish the discs with more fluid which improves the long-term health of the disc. Strength training with big, heavy movements such as deadlifts are helpful to teach your muscles how to do the job, rather than putting all the pressure on the spine.
Don't be fearful to move
So rather than hearing your doctor diagnose you with “degenerative disc disease” and be fearful to move, know that this is a common diagnosis and is part of the normal aging process.
Just because you are getting older and “wrinkled” does not mean you cannot lead a fulfilling and active life. In fact, staying active is the best thing you can do to reduce your back pain and symptoms.
References:
Samanta A, Lufkin T, Kraus P. Intervertebral disc degeneration—Current therapeutic options and challenges. Frontiers in Public Health. 2023;11. doi:https://doi.org/10.3389/fpubh.2023.1156749
Does Physical Loading Strengthen the Intervertebral Disc and Retard Disc Degeneration? The Back Letter. 2006;21(7):73. doi:https://doi.org/10.1097/00130561-200607000-00001
Chan SCW, Ferguson SJ, Gantenbein-Ritter B. The effects of dynamic loading on the intervertebral disc. European Spine Journal. 2011;20(11):1796-1812. doi:https://doi.org/10.1007/s00586-011-1827-1
Costăchescu B, Niculescu AG, Teleanu RI, et al. Recent Advances in Managing Spinal Intervertebral Discs Degeneration. International Journal of Molecular Sciences. 2022;23(12):6460. doi:https://doi.org/10.3390/ijms23126460
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