What changed? Chronic back and neck pain used to be a condition that impacted primarily the elderly from what was thought to be the inevitable result of advanced age; today, younger and younger patients present with Degenerative Joint Disease (DJD).
When I began practice over 30 years ago degenerative changes of the spine were not even considered to be a realistic possibility in anyone under the age of 60. Sure, there were occasional exceptions such as the retired Major in his 50's with over 800 career parachute jumps but these instances were rare. In a few short decades the incidence of true degenerative findings in younger patients has increased alarmingly. What has changed?
First, it is helpful to describe the meaning of the phrase Degenerative Disc Disease (DDD) or Degenerative Joint Disease (DJD). Patients often harbor hazy notions that this somehow means the bone has eroded or worn away, and that the spinal discs have in some way dissolved or disintegrated. Actually, the diagnosis is made by 3 specific radiographic findings: the disc has begun to dry out as can be determined by how white it is on the image, the dry disc has begun to lose height resulting in adjacent vertebra becoming closer together, and finally the stress on the bone and ligaments which one would at first suppose would wear down the bone actually results in a buildup of bone much in the same way that stress to the skin on the palm of your hand results in a buildup of skin called a callous. With bone this calcium buildup is known as osteoarthritis or bone spurs.
So, if degeneration means a progressive dryness, thinness, and calcium build-up that leads to chronic back and neck pain, then steps taken to prevent or reverse this and rehydrate the disc, restore the lost height, and eliminate the stress on the joint would help neck and back pain. But, why does a disc degenerate?
What Causes a Spinal Disc to Dry Out?
To understand why a spinal disc would dry out it is first necessary to understand some of the basic anatomy of a disc. A disc resembles in some ways an automobile tire sandwiched between two spinal vertebra. However, the rubbery part on the outside is really a fibrous, ligamentous-type tissue, and the inside, rather than being filled with air like a tire, is really filled with a jelly-like protein substance that is designed to absorb shock. There are no blood vessels that penetrate the rubbery outside layers to supply oxygen and nutrition to these living cells. Instead, the intervertebral discs depend upon normal motion, or a pumping action, to move fluid and blood flow through them which arrives through the end-plates of the vertebra above and below the disc. Anything that hinders the normal motion or pumping action, or lessens the ability of the blood to deliver oxygen or nutrition compromises the health of the disc tissue. A healthy disc is a bit like a hockey puck in that it nearly can't be hurt, but a dry degenerating disc is injured again and again at every turn each injury further restricting the joint motion and limiting the pumping action which accelerates the process.
Unlike past generations, in our modern society much of the food we eat has been processed and now contain preservatives and other additives. Foods are canned, frozen, or micro-waved all of which compromises some of the nutritional value. Worse, much of what we consume has been exposed to herbicides and pesticides further challenging our metabolic processes. These same herbicides and pesticides contaminate our ground water as well. Other environmental pollutants found in our air and water such as emissions from automobiles and industries, radiation, asbestos, and many others all contribute to metabolic stress. Smoking, alcohol, and pharmaceuticals are also contributing factors.
The answer here is to strive to have a healthy diet. A donut and a cup of coffee is not a nutritious breakfast, and super-sized fries and a soft drink is not a nutritious lunch. If your idea of preparing dinner is any meal that requires more than 4 minutes in the micro-wave you're asking for trouble. If essential nutrients are not in your diet how can they find their way into the disc and other cells of your body?
These same poor health habits also contribute to the obesity epidemic in the modern nations of the world. Excessive weight also stresses the disc.
Any number of factors in addition to advanced age can cause or contribute to degenerative changes. In our modern society many of us spend hours sitting at a desk not once moving enough to pump precious fluids through the discs. Further, not enough exercise results in a gradual weakening of the supporting muscle and ligamentous structures making the discs prone to injury from even ordinary everyday activities as we use our backs each day through sitting and standing, bending and lifting. Too little activity during the week followed by too much activity on the weekend can also result in injury. Naturally, traumatic falls or accidents can directly injure even a healthy spinal joint, but is made all that much worse if it is in a weakened state to start. Repeated episodes of even minor injuries can eventually result in muscle tension and/or inflammation limiting the motion, and thusly the pumping action of the disc, which becomes progressively stiffer and drier causing it to lose its shock absorbing properties, and make it that much more likely to sustain yet the next injury. This is the very definition of degeneration where each incident lowers the pain and subsequent injury threshold so that eventually the most ordinary of activities such as walking through the grocery store is too much. There may also be an as of yet unidentified genetic factor causing some individuals to be more likely to develop this condition.
Any combination of events or circumstances that result in a weakening of the outer annular fibers of the disc may eventually lead to a bulging or herniation of disc material that can pinch the adjacent nerve root or spinal cord causing additional problems.
The answer here is to maintain a normal weight and be physically fit.
Can Degenerative Changes Be Reversed?
In the past, a patient suffering from this degenerative process was usually given pain medications or injections, instructed to refrain from physical activities, referred for physical therapy, and when they weren't progressing they were sent for spinal surgery or simply told to learn to live with it. Since 2001 when the FDA finally approved non-surgical spinal decompression therapy, there is new hope for those who suffer from degenerative joint diseases. Spinal Decompression Therapy is a non-invasive, non-surgical treatment performed on a special, computer controlled table similar in some ways to an ordinary traction table. A single disc level is isolated and by utilizing specific traction and relaxation cycles throughout the treatment, along with proper positioning, negative pressure can actually be created within the disc. It works by gently separating the offending disc 5 to 7 millimeters creating negative pressure (or a vacuum) inside the disc to pull water, oxygen, and nutrients into the disc, thereby re-hydrating a degenerated disc and bringing in the nutrients needed to heal the torn fibers and halt the degenerative process. As the disc is re-hydrated the shock absorbing properties are restored and the stress on the joint is reduced and the inflammation subsides. Many times much of the lost height can be restored as well. Now a normal life can be resumed.
Dr. Michael L. Hall, D.C. practices at Triangle Disc Care in Raleigh, North Carolina specializing in Spinal Decompression for the treatment of acute and chronic neck pain and back pain due to herniated, degenerated discs. This is a conservative procedure for patients suffering with bulging or herniated discs, degenerative disc disease, posterior facet syndrome, sciatica, failed back surgery syndrome, and non-specified mechanical low back or neck pain.