A Physical Therapy Guide to Degenerative Disc Disease
Up to 80% of people experience neck or back pain at some point in their lives.1 Degenerative disc disease is a common diagnosis for people with back and spine pain. The likelihood of this diagnosis increases with each decade of a person's life.
The good news is that many with degenerative disc disease have no symptoms or functional problems whatsoever.
Understanding spine pain can feel overwhelming given the conflicting information available to the average person. Working with a movement expert — such as a doctor of physical therapy at CityPT — can give you the confidence that you know how to keep your spine healthy as you age.
For those who are experiencing pain or other symptoms from degenerative disc disease, most can manage their condition conservatively, without surgery.
Continue reading to learn more about symptoms, causes, and treatment options for spine pain caused by degenerative disc disease.
- Understanding Degenerative Disc Disease
- Symptoms of Degenerative Disc Disease
- What are the Most Common Causes of Degenerative Disc Disease?
- Diagnosing Degenerative Disc Disease
- What to Expect from Physical Therapy
- What If Conservative Treatment Doesn't Work?
- Preventing Degenerative Disc Disease
- Is It Time to Seek Treatment?
Your spine has three main regions, which work together to allow you to turn, bend, and extend:
- Cervical, or neck
- Thoracic, or mid-back
- Lumbar, or lower back
Below the lumbar spine are the sacrum and the coccyx, also known as the tailbone. Each consist of a set of fused vertebrae that do not move.
Your cervical, thoracic, and lumbar spine consist of a series of small bones, called vertebrae. Each vertebra is separated from the one above or below by a strong, flexible disc, called an intervertebral disc. The discs are reinforced further by sturdy bands of ligament and muscle.
Your spinal cord runs vertically through a series of openings on the back side of each vertebra. A pair of small nerves or "nerve roots" exit the spinal cord between each vertebrae, one for the left side of the body, and one for the right side of the body. These nerves control motor function and send information to your brain about sensations in that region of the body.
Disc Anatomy, Function, and Changes with Aging
The most common areas for developing degenerative disc disease are in the cervical spine and the lumbar spine. Degenerative disc disease in the thoracic spine is unusual. The sacrum and coccyx do not have discs.
As mentioned, the outer part of the intervertebral disc is a strong fibrous material, reinforced by ligaments and muscle. The inner part of the disc is made of a dense gelatinous substance containing a high percentage of water. This anatomy allows the discs to cushion the spine in weight bearing and gives them strength and flexibility to change shape in response to movements and loads in all direction.
With aging, we naturally lose some of the water content in the discs, resulting in a loss of some of their "springiness." They tend to get slightly shorter with each decade of adulthood when viewed from the side. This is a large contributor to the body height we lose when we age.
The discs may lose some of their round shape as well, developing a more irregular shape when viewed from above. This bulging is often called a herniated disc. A herniated disc can also occur as a result of an acute injury.
Other Age-Related Changes in the Spine
Along with disc changes, there may be changes in the vertebrae, such as bone spurs — also called osteophytes.
Changes to the disc and/or changes to the vertebrae may result in pressure or irritation to nerves or spinal cord.
As with disc changes, pressure to the nerves or spinal cord usually does not cause any symptoms or problems. Symptoms and treatments, when these age-related changes do cause irritation or other symptoms, are discussed further below.
Degenerative disc disease is often asymptomatic. In people with no spine-related symptoms, the percentage of individuals with degenerative changes in their spine increases steadily with each decade of life. One compilation of studies found that the prevalence of disk degeneration on imaging for pain-free people increased from 37% of 20-year-olds to 96% of 80-year-olds.2
While some people do have symptoms coinciding with these spine changes, they are not always a part of this aging process. If symptoms are experienced, they might include:
- A feeling of pain or stiffness along the spine
- Pain or sensory changes — such as numbness or tingling — into the arm or leg
- Weakness in the affected limb
When the symptoms extend into your limb, this likely indicates irritation to the nerve adjacent to that disc. Rarely, people experience compression to the spinal cord severe enough to prevent walking and other functions of the lower body.
Please note: A new or recent onset of low back pain with severe loss of function in the legs or bowel/bladder, loss of sensation in the genital area, or loss of sexual function could be indicative of a medical emergency.
If you are experiencing these symptoms, seek emergency care.
Degenerative disc disease is a common condition which increases in frequency with age. Aside from the normal aging process, people with other comorbidities3 may be at a higher risk for degenerative disc disease:
- Heart problems such as cardiovascular disease or hypertension
- Smoking and/or COPD
Degenerative disc disease may also be more common among those who have a low level of physical activity or those who work a physically demanding job.
As mentioned above, many people do not even realize they have age-related disc changes, since they have no symptoms or other limitation in their daily life. For this reason, degenerative disc disease is not truly a disease.5
An X-ray or MRI showing age-related changes would confirm the diagnosis for symptomatic people. Often, imaging only occurs if someone's symptoms do not improve with conservative treatment.
At your first meeting with your clinician — whether that is a doctor of physical therapy at CityPT, or another licensed healthcare professional — they will ask you specific questions to determine whether urgent imaging would be recommended to check for more serious neck or back issues. However, absent any red flags for serious pathology, an imaging study or diagnosis is not required to begin pain-relieving treatment.
The most important thing for your physical therapist to understand is what your pain and symptoms are keeping you from doing. Do you feel the pain primarily at night, keeping you from sleep? Do you feel it when turning your head while driving? Is it mostly at work, while on your computer?
Understanding this will help drive the treatment that is most meaningful for you.
Your CityPT therapist will create a tailored treatment plan for you based on what they observe about your strength and movement, as well as what you tell them at your initial evaluation.
Treatment will vary depending on your symptoms and goals but could include any of the following:
- Education about your condition: Such as recommendations for ice, heat, exercises, and other ways to improve the pain around your spine. They will also work with you to address some of the underlying factors that may be contributing to your pain, such as regular exercise, stress, or smoking.
- Symptom-reducing treatments: Typically a combination of gentle exercises and hands-on manual treatments to help decrease the severity of pain or numbness in your limbs.6
- Treatments to improve your range of motion: To decrease feelings of pain and stiffness with your daily activities— again this is typically a combination of exercise and manual therapy. Targeted exercises can help your body move in a smoother and less painful manner.
- Return to desired activity level: Whether that is sport, occupation, recreational activities—your physical therapist will help you develop and implement a plan so that you have the strength, flexibility, and endurance required by your activity.
If you are not seeing improvement with conservative management, such as exercise and physical therapy, it is important to discuss alternatives with your care team.
Alternatives may include:
- Spinal injections
- Spinal fusion surgery
- Disc replacement surgery
As discussed, there are several factors which may play a role in the development of degenerative disc disease. The current understanding is that these factors are correlated with the development of this condition—that is, many people with one or more of the factors also has degenerative disc disease, but it is still not clear which one causes the other. It is still likely helpful for you to:
- Quit smoking to improve blood flow to your spine.
- Work with your physician to manage cardiovascular conditions.
- Engage in regular physical activity. Regular exercise may contribute to the health and resilience of the discs themselves.7
- Exercise can also help with energy, mood, and metabolic conditions—such as diabetes—which may contribute to the development of degenerative disc disease.
- Consuming wholesome and nutritious foods helps with metabolism as well.
- Getting enough sleep and managing stress for overall health and injury prevention.
If you are currently dealing with neck or back pain and don't know where to start, you would benefit from working with a CityPT physical therapist. This is true whether you suspect degenerative disc disease or already have a diagnosis.
Get in touch with one of our CityPT specialists and book an appointment to get started on your path to recovery.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Sinnot PL, Dally SK, Trafton J, Goulet JL, Wagner TH. Trends in diagnosis of painful neck and back conditions, 2002 to 2011. Medicine. 2017; 96(20). DOI: http://dx.doi.org/10.1097/MD.0000000000006691 ↩
Brinjikji W, Luetmer PH, Comstock B, et al, Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015; 36:811–16. DOI: https://doi.org/10.3174/ajnr.A4173. ↩
Jakoi AM, Pannu G, D'Oro A, et al. The clinical correlations between diabetes, cigarette smoking and obesity on intervertebral degenerative disc disease of the lumbar spine. Asian Spine J. 2017;11(3):337-347. DOI: https://doi.org/10.4184/asj.2017.11.3.337. ↩
Mitchell UH, Helgeson K, Mintken P. Physiological effects of physical therapy interventions on lumbar intervertebral discs: a systematic review. Physiother Theory Pract. 2017;33(9):695–705. DOI: https://doi.org/10.1080/09593985.2017.1345026 ↩
Steele J, Bruce-Low S, Smith D, Osborne N, Thorkeldsen A. Can specific loading through exercise impart healing or regeneration of the intervertebral disc? Spine J. 2015;15(10):2117-2121. DOI: https://doi.org/10.1016/j.spinee.2014.08.446. ↩