Lumbar Degenerative Disc Disease - What Should I Do?
Dr. Luke Henry, Chiropractic Physician
Patients often ask me, "I have a disc problem - what should I do?".
Disc Disease - A Frequent Cause of Back Pain
80% of Americans suffer from low back pain. Back pain is one of the most frequent reasons patients see a physician. Low back pain is a leading cause of disability worldwide. One of the commonest reasons for back pain is degeneration of the discs in the lumbar (lower back) spine. I discussed other causes of back pain in another article. Some studies have suggested a genetic predisposition to disc degeneration. Discs degenerate in response to mechanical stress. This may be the result of injury (for example, heavy lifting, sports injury, or motor vehicle accident) or repetitive strain. The disc is composed of the outer annulus fibrosus and the inner nucleus pulposus. Disc disease may include bulging, herniation, stenosis (narrowing of the space around the nerve roots or central canal), or instability. Basically, the discs are like shock absorbers in the spine. When they wear or become injured it is easy for nerves to be pinched or irritated causing pain. Because the nerves that come out of the lower back go down the legs to the feet, pain may be localized to the back or may radiate down a leg (for example, sciatica) or result in numbness, tingling or weakness.
Diagnosis of Degenerative Disc Disease
Doctors of chiropractic are trained to diagnose disc problems by taking your medical history and doing a physical examination. Radiographs (x-rays) are useful for imaging disc degeneration, degenerative arthritis at the facet joints and stenosis. MRI is generally preferred for imaging the discs to evaluate bulging, herniation or radiculopathy (i.e. pinched nerves). Diagnostic imaging is useful but isn't perfect. Sometimes there's a false positive (for example, a disc problem shows on imaging but it's not causing pain) or a false negative (something is missed on the imaging). That's why imaging must be correlated with what the doctor observes clinically. It is also quite common to have a disc problem that is asymptomatic (not causing pain or other symptoms) that becomes aggravated after an injury (e.g. auto accident or falling).
|Lateral lumbar x-ray showing severe disc degeneration.|
Progression of Disc Disease
Sometimes back pain will get better on its own without any treatment or with home care (hot / cold, over the counter medicine (ibuprofen, naproxen, etc.), stretching, etc.). However, I doubt if you would be reading my article if that were the case. It is also possible for disc problems to worsen suddenly, requiring immediate surgery in the event of loss of bladder or bowel control or progressive neurological deficit (e.g. paralysis). This can happen even with minor jarring, "moving the wrong way" or sneezing. Fortunately, this is quite rare. More commonly, disc problems gradually worsen with aging and wear and tear, resulting in more frequent and more disabling episodes of pain. With aging, worsening stenosis and resulting nerve compromise can produce leg pain, numbness, tingling and weakness that make it difficult to do normal daily activities like shopping for groceries, standing for prolonged periods, or even walking to the mailbox.
Injections and Back Surgery
Lumbar epidural injections make use of a steroid medicine to reduce pain and inflammation. Neurosurgeons and orthopedic surgeons both do spine surgery. Back surgery can be minimally invasive (e.g. laser surgery or microdiscectomy) to try and "clean up" the area around the pinched or irritated nerve. Decompressive surgery may include laminectomy, cutting the bony back part of the vertebra out, "like cutting the roof off a house", to make more room for the nerves. Fusion surgery involves cutting out the disc and fusing the bones together. While injections and surgery sometimes are the best option (chiropractic physicians are appropriately trained to refer patients to other providers when it is in the patient's best interest), these procedures have significant cost and risk. Meningitis, a serious condition, may result from tainted epidural injections. Steroid medicine may aggravate blood sugar abnormalities and there is a small risk of stroke. Risks of surgery include infection, blood clots, paralysis, incontinence, need for more surgery and death. I am happy to refer my patients for consultation for injections / surgery or just for a second opinion. Sometimes we co-manage patients, for example, a patient may receive medication and injections along with chiropractic treatment. Generally, when it comes to back pain it is better to try conservative care first, as has been recommended by the University of Pittsburgh Medical Center, and keep invasive options as a last resort.
Thankfully, there are effective treatment options that are much safer and less expensive than injections and surgery. Chiropractic may help avoid surgery. Most insurances cover chiropractic services, although there may be limits on how much and what is covered (like dentistry). Chiropractic manipulation (AKA adjustment) restores alignment and normal motion to dysfunctional joints in the spine, alleviating irritated nerves. Chiropractic physicians also use physiotherapy modalities, such as hot / cold, electrical stimulation, ultrasound (a type of deep heat), traction, soft tissue treatments (massage, myofascial release, mobilization), and therapeutic exercises. Since every person is different, a good chiropractor will offer a variety of treatment options with a treatment plan customized for each patient. Some patients will be better served with a gentler treatment approach. Some exciting new technologies have developed to help pain sufferers. Low-level laser therapy (AKA "Cold laser") helps to reduce inflammation and pain by stimulating the tissues with a special kind of light. I discussed recent scientific evidence for low-level laser therapy for pain in an earlier article. Nonsurgical spinal decompression is a type of computerized spinal distraction that lowers pressure inside the discs, encouraging the disc to absorb water and nutrients, increasing disc height and reducing pressure on nerves. Biofreeze, hot / cold packs, TENS units and braces help control pain between visits.
What can you do to help yourself?
1) Avoid tobacco. Smoking is a known contributor to disc degeneration. South Carolina has a smoking cessation program.
2) Lose weight. We can help. There are many effective options. Less weight means less pressure on the discs and nerves in the back. This also often helps arthritis in the knees and hips and reduces pain in the feet. Getting rid of unwanted fat will reduce risk of diabetes, heart disease and cancer, make you look better, feel better and be healthier.
3) Exercise. The discs in the spine get their nutrition from diffusion through motion, sucking up nutrients like a sponge. When you sit all day the discs in the spine starve. Exercise is also part of an effective weight loss solution. Choose an activity you enjoy so it will be easier to stick with it. You should try to incorporate strength, flexibility and cardio into your workout routine. Strengthening the core is especially important to protecting the back.
4) Increase hydration. Discs are mostly water. Staying well hydrated helps. It also helps with weight loss.
5) Eat healthy. Of course, this helps with managing weight but also helps reduce inflammation that causes pain. Avoid processed foods and empty calories from excess sugar or alcohol. Be sure to get adequate protein and get your phytonutrients from fruits and vegetables.
While you can't control your genetics, you can do a lot to improve your health through diet and exercise. While these suggestions may be simple, they are not easy. Improving your spinal health means improving your overall health. A good chiropractor can help you to manage your back pain and will aid you in achieving a healthier lifestyle.
Dr. Luke Henry, Chiropractic Physician
1314 Pelham Road, Greenville, SC 29615