Degenerative Disc Disease: What You Need to Know

By Dr. Devi E. Nampiaparampil (“Doctor Devi”)Departments of Anesthesiology and Rehabilitation Medicine, NYU School of Medicine

Degenerative Disc Disease: What You Need to Know

“You’re lucky you can walk with a spine like that!” These are the words that Bill Kilpatrick* (age 48) heard while consulting with a chiropractor. Bill’s lower back symptoms started in his 20s and he attributed them to football injuries. He didn’t focus on the pain especially since each episode typically resolved spontaneously.

When Bill reached his 30s, the severity, duration and frequency of each pain episode increased. Anxious about triggering symptoms, Bill curtailed activities he had previously enjoyed. He smoked regularly and noticed that intermittent smoking breaks afforded him some pain relief.

By his 40s, Bill had a low level of back discomfort, which was punctuated with episodes of acute pain that incapacitated him for days. He had stopped exercising, and, because he was afraid of inciting the pain, he had limited most of his activities. He had spent years avoiding bending – even to tie his shoelaces – and had become less flexible. His back was stiff. Ultimately, as Bill moved through the healthcare system, he discovered that he had “degenerative disc disease.” So what does it mean to have degenerative disc disease?

What Is Degenerative Disc Disease?

Your spine is comprised of bones, called vertebral bodies, which stack on top of each other to form a column. This column serves as a structural support for your entire body. Between those bones, you have “discs” or cushions, which act as shock absorbers. They prevent the bones from hitting each other when you walk, jump, run or do other activities. Over time, these discs sustain wear-and-tear type injuries and start to dry up a little. Sometimes, they get flattened; occasionally, they bulge out to the sides. By the time we reach age 30, some of us may show signs of these degenerative disc changes.

When scientists first noticed these changes in the discs, they coined the term “degenerative disc disease.” But as we now know, the term “disease” is actually a misnomer. The breakdown or “degeneration” of the discs is actually a normal – but potentially painful – part of the aging process. In one study, doctors obtained magnetic resonance imaging (MRI) scans of the backs of people without low back pain. The MRIs showed that many of these people had “degenerative disc disease” even though they had absolutely no symptoms.

So if degenerative disc disease is “normal,” why is it so painful for some? Right now, doctors and researchers don’t know what causes discs to start hurting but they are working diligently to find out. We do know that certain activities put more stress on already painful discs. For example, sitting puts more pressure on your discs than lying down or standing. Sitting, bending, and twisting – a position many of us assume repetitively at the office – puts a tremendous amount of pressure on our discs. For people who already have pain related to wear-and-tear on the discs, these positions tend to be the worst.

What You Can Do To Ease The Pain of Degenerative Disc Disease?

“Being active and flexible is the ultimate goal for back pain resolution,” says Dr. Mila Mogilevsky, a pain management specialist at Beth Israel Medical Center and the founder and Medical Director of Unique Pain Medicine. She explains, “In our practice, we start and end with physical therapy. Treatments such as medications and interventional procedures serve to act as a ‘bridge’ allowing patients to get back to a healthy exercise program.”

Yoga may also be a useful tool for certain patients. Dr. Mogilevsky reveals, “Yoga is a great way to improve flexibility without putting extra strain on the joints. It is also a unique opportunity to connect your mind and body, which is so important for the healing process.”

Are there certain vitamins or anti-oxidants we can use to alleviate low back pain? Unfortunately, at this time, there is no one food that will immediately relieve back pain. However, there are dietary modifications that might help over the long-term.. Scientists have discovered that high blood pressure and high cholesterol also affect the arteries carrying blood and other nutrients to the discs of the spine. When those arteries get damaged, it becomes harder for the discs to heal. This perpetuates the cycle of low back pain.

Eating heart-healthy foods rich in omega-3 fatty acids, like salmon and tuna, and having a diet rich in whole grains, beans and nuts will improve the health of your spine by improving your blood pressure. Controlling your blood pressure and cholesterol will not only help your heart – it will help your spine.

If healthy living can help prevent and treat back pain, can smoking worsen it? The evidence suggests smoking does worsen back pain. Many folks like Bill smoke to cope with their pain. Unfortunately, studies show that smoking can damage the arteries going to the spine in the same way it might damage the arteries going to the heart. Dr. Joanna Kuppy, an Assistant Professor of Pediatrics at Rush University notes, “Tobacco use has adverse effects on many organ systems. People know about the effects on your heart and lungs in terms of the increased risk of heart attacks and lung cancer. Most people do not realize that smoking may contribute to musculoskeletal problems as well.” Some evidence suggests that low back pain is much worse in smokers than non-smokers4,5.

In Bill’s case, we don’t know what started the pain. It might have been a combination of his genetics, his environment and the wear-and-tear that his body took over time. What we do know is that certain things made the symptoms worse. By increasing his flexibility, modifying his diet, and quitting smoking, he has the ability to improve his low back pain symptoms. The lesson: Each of us has the ability to improve our own health.

*Bill’s name has been changed for privacy but his story is familiar to many of us.

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