The Truth About Your Degenerative Discs

By Jonathan S. Chu, M.D.

Interventional Pain Management

Physical Medicine and Rehabilitation

The intervertebral discs are the flexible cartilage pads between the bones of the spine (vertebrae).

 

They act as cushions and help you to bend and twist throughout your day. They are the main source of mobility in both your neck and low back.

Every time you take a step, they help to act as natural shock absorbers and help you bear the loads from your upper body.

 

Hence, it can be pretty disconcerting when your doctor gets an MRI of your spine and tells you that you have degenerative discs!

 

My patients often have lots of questions when they see this finding on their imaging reports.

 

Does this mean my discs are badly damaged?
Will my discs ever get better?
Are they going to get worse over time?

 

I can definitely understand your fears. It’s okay to take a deep breath and take a step back for a moment.

 

Degenerative discs, though potentially painful, are an extremely common finding in the population, and are not always a bad thing.

 

Let me explain to you what the term actually means, how it relates to your back pain, and hopefully assuage some of your concerns.

First, let’s talk about normal discs.

 

In your teen years, your discs were probably in great shape.

A normal disc has a strong and healthy annulus on the outside. These are the cartilage rings that surround the outside of the disc, kind of like a car tire.

 

The inside of the disc is called the nucleus. In a healthy disc, this is filled with soft collagen and elastin fibers, as well as water.

 

Overall, it truly is an amazing structure designed to bear lots of stresses from bending and loading. It takes a lot of abuse through the millions of spine motions you make during your lifetime!

So then, what is a degenerative disc?

 

With increasing age and wear and tear, the discs in your spine can degenerate.

 

This means that a few changes take place in the disc over time.

 

1) The nucleus, or inner portion of the disc, loses its gel-like quality and becomes more dehydrated

2) The fibers on both the outside and the inside of the disc become more chaotic and disorganized

3) Small cracks and fissures start to appear throughout the outer annulus of the disc

 

With these changes, the discs are not able to bear loads as efficiently. Also, they are more prone to herniate and sustain other injuries.

This may all sound really bad to you if you’re hearing this about this for the first time.

 

But don’t panic.

 

The first thing to know is this:

Degenerative disc disease is exceedingly common.

I always tell my patients this: if you live long enough, you will eventually develop some degeneration of the discs or other areas of the spine. No one can escape it.

In fact, it’s reported that over 60 percent of all people over the age of 70 have severe degenerative disc disease.

 

Since the discs are subjected to such a variety of repetitive stress over the years, wear and tear is inevitable.

 

Some people are lucky. They have great genetics and may not develop degeneration until much later in life. Also, their degeneration may be mild.

Others are less fortunate. They may have genetic predisposition to developing disc degeneration. They may have worked a job that placed lots of repetitive stress on the spine over the years. These patients will often develop more pronounced degenerative changes earlier in life.

 

In summary, it’s easiest to think of degeneration as aging of the spine—the expected changes that occur with wear and tear.

Some spines may age a little faster than others, but no one can avoid having at least some degeneration as they get older.

Does This Mean I’ll Have Pain Forever?

 

It can be tremendously overwhelming to look at an MRI report and see all the degenerative changes listed.

 

“Dr. Chu, my MRI shows that I have 3 degenerated discs in my spine! That’s very bad, right?”

 

The answer is a little complicated.

 

When looking over your imaging reports, is critical to keep in mind that degeneration does not translate directly to pain.

 

Pain is all about inflammation.

 

As I mentioned above, a large portion of the population lives their day-to-day life with degenerative discs.

Yet they live with minimal pain, enjoying their lives.

Many may not even know they are living with degenerated discs.

 

Thus, it’s important that keep in mind that most adults live their lives with degenerated discs that are not actively inflamed or painful.

 

However, it’s also important to keep in mind that a degenerative disc is more susceptible to injury.

A worn out disc is more likely to herniate and press on a nerve root, causing sciatica (pinched nerve pain). This comes with a lot of painful inflammation around the nerve root and the disc injury itself.

 

Nevertheless, after you take the appropriate steps to recover from your flare-up, the inflammation will eventually subside, and you will feel good again.

Thus, while degenerative discs can be more likely to develop flare-ups, most people feel quite normal in-between flare-ups.

 

So you can see, having degenerative discs definitely does not translate to a life of constant pain. In fact, most people with degenerative discs live very active and enjoyable lives.

How To Keep Your Discs Healthy

 

There are a few factors that lead to the development of degenerative discs.

 

As we mentioned above, the one them is genetics.

Unfortunately, some people are just born with discs that wear out faster.

This is not a factor under your control, so I’m not going to focus on it.

 

The good news is that the next two factors are definitely in your control.

 

First, you should make sure your discs get adequate nourishment.

 

In general, discs don’t have a very good blood supply. They obtain all of their nutrition from blood vessels in the surrounding bones.

To make sure your discs get better nourishment, it is important to engage in regular exercise to increase circulation to the spine.

 

Most of my patients with back pain do best with low-impact cardiovascular exercise.

This can take the form of the elliptical machine or a recumbent bicycle machine.

It can also be something as simple as going for a nice walk a few times per week.

If walking on land is hard to tolerate, many patients enjoy walking in a pool, which helps to decrease the load on all their joints.

 

Overall, regular exercise helps to promote better blood flow to the disc so it obtains the nutrition it needs.

 

Along these lines, you should also make sure reduce or eliminate anything that has a negative effect on your circulation. So if you are a smoker, this definitely means quitting. It also means controlling your blood sugars if you are diabetic.

 

The Next Factor is Mechanical Stress

 

While normal exercise does not affect the discs—excessive and repetitive loads on the spine have been shown to speed up the degenerative process.

 

If you are overweight, one of the best things you can do is to work on losing weight. This will greatly reduce the burden on your discs throughout your day-to-day activities. Many of my patients have noticed an improvement with just 5 to 10 pounds of weight loss.

 

Next, it’s very important to lift with smart body mechanics.

Directly bending over to lift a heavy object can place a lot unneeded pressure on your discs. Keeping your spine straight and lifting with your legs is far better. You should also ask for help when attempting to lift heavier objects.

 

Improving the strength of your core muscles is also very crucial.

 

You see, your spinal and abdominal muscles act as scaffolding that supports the spine. If you strengthen your core muscles, they act as a natural back brace, protecting your spine through day-to-day stresses.

 

Also, if you work at a desk, sitting with good ergonomics is very helpful as well. Most people spend their days slouched over their desks and electronic devices. This places extra pressure on your discs constantly throughout the course of the day. Over time, this can definitely take a toll on your discs.

 

You should strive to maintain a neutral spine position as much as possible. This means sitting with a natural and comfortable posture.

Your monitor should be kept at eye level, your feet should be flat on the floor, and your spine should feel like a well-balanced stack of blocks. Lastly, you should also take a few minutes to stand and stretch every hour.

Thank you so much for reading. I greatly commend you for taking the time and effort to educate yourself about your pain.
As a physician, I believe it is so crucial to take a proactive approach to your health.
I know that your dedication will pay off over time.

 

Until Next Time,

Jonathan S. Chu, M.D.

About the Author

Dr. Jonathan S. Chu is a physician who specializes in Interventional Pain Management and Physical Medicine and Rehabilitation (PM&R), and is the founder of 360 Pain Academy.

 

Dr. Chu earned his medical degree from the Penn State College of Medicine / Milton S. Hershey Medical Center. Afterwards, he completed an internship in Internal Medicine at Lankenau Medical Center. Next, he pursued residency training in the field of PM&R at the Weill Cornell Medical Center and Columbia University Medical Center Combined Program. He went on to fulfill a fellowship in Interventional Pain Medicine at the University of California, San Diego Medical Center, where he learned advanced procedures for the treatment of pain from renowned leaders in the field.

 

He is double board certified in Physical Medicine and Rehabilitation and Pain Medicine.

References:
Benzon HT, Raja SN, Liu SS, Fishman SM, and Cohen SP. Essentials of Pain Medicine. 3rd Ed. Philadelphia, PA: Saunders; 2011.

Braddom RL, Chan L, Harrast MA, Kowalske KJ, Matthews DJ, Ragnarsson KT, and Stolp KA. Physical Medicine and Rehabilitation. 4th Edition. Philadelphia, PA: Saunders; 2011.

Choi YS. Pathophysiology of Degenerative Disc Disease. Asian Spine Journal. 2009 Jun; 3(1): 39–44.

Furman MB, Lee TS, and Berkwits L. Atlas of Image-Guided Spinal Procedures. 1st Ed. Philadelphia, PA: Saunders, 2013.

Rathmell JP. Atlas of Image-Guided Intervention. 2nd Ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2012.

Urban JPG and Roberts S. Degeneration of the intervertebral disc. Arthritis Research & Therapy. 2003; 5(3): 120–130.

WordPress Theme built by Shufflehound.