Degenerative Disc Disease In The Low Back: The Essential Guide

Degenerative disc disease is a diagnosis you might be given for lower back pain, but with its use for those in their 20’s and beyond their 60’s alike, what does this diagnosis really mean when it comes to lower back pain. Unfortunately, one of the major features of medical care, much like perhaps the legal industry and finance, is the prevalence of using fancy terminology to create a degree of confusion in “outsiders” to the profession. Granted technical jargon does have a use when communicating from one professional to another, but all too often the translation for the layperson is not made. 

Today we will break down what this degenerative disc disease means as well as draw on our experience over the years to help you better understand how a diagnosis such as this will impact your lower back pain recovery for both the short term, but also your long term wellbeing.

The disease in degenerative disc disease for your lower back

The most important starting point is to talk about the use of the word disease in degenerative disc disease. The moment we hear the word disease, it brings to mind connotations that are certainly not positive. Typically you might think of infections, diseases such as malaria or autoimmune diseases. But when it comes to degenerative discs the mental connotations of what constitutes a disease immediately skews the diagnosis in a more unfavourable light in the mind of the patient. In many cases this skew inherent in the naming of the condition is fundamentally unhelpful, untrue and unnecessary. Granted, we could make the case that a slight negative skew might well spur one on to take action necessary in a way that might otherwise not occur, but that’s for another time. If you are someone suffering from back pain and you’ve been given the diagnosis of degenerative disc disease, take the first step to understanding this and remove the last D!

What is degenerative disc disease in the lower back?

In short it means that the discs which are like small cushions between the vertebral blocks have degenerated. We will go into reasons for this and what to do going forwards later, but for the time being simply understand it is a statement that the health of these particular discs has been compromised to some degree. Unfortunately, degenerative disc disease is not one of those diagnoses that has a scale attached to it, like the grading in the case of spondylolisthesis. Because of this fact, the diagnosis feels rather binary to the individual, either you have it or you don’t. When a nuanced understanding is much more helpful. 

The scale of degenerative disc disease

One helpful way of understanding this diagnosis is to think of it as a scale, on the one hand, the complete degradation of the intervertebral disc takes place to the point where the two vertebrae that are separated by the disc become fused. This would be complete degeneration if we were to make up a category. With the fusion of the two vertebrae the degenerative process is complete and essentially the disc has gone. This would take a very long time, perhaps even a lifetime! Having said that, it could be expedited by a number of things, such as a herniation or surgical decompression which would remove parts of a bulging disc. On the positive end of the scale we would have a perfectly healthy disc, of full normal height.

The first signs of the degeneration process would be the evidence of a dehydration of the discs in the spine, this is very clearly visible on MRI imaging, in which the discs ordinarily will show up as a white-like colour, as they degenerate, turning more grey. 

Measuring the sale of degeneration of your discs

Degenerative disc disease is one of those which lends itself to education via one’s own imaging. Should you have an MRI, which is how this diagnosis is typically made, it is very clear on the images. You can see the disc that may well be degenerative and you can compare this to others in the spine that are not – more on this later. 

This is one of the great failures of the way in which medical imaging tends to be used these days, imaging is simply used to inform a practitioner, be they your GP, osteopath or surgeon. The verbal or written report is then given to you, the thing may as well be written in Latin! Images on the other hand, can be explained to a child with “spot the difference”. It sounds simple but it really is when it comes to a diagnosis like degenerative disc disease, perhaps other diagnoses might be more complex to explain, but this one is simple.

Discs that are large and white and remaining within their borders, i.e. in line with the vertebra, could be considered to be “healthy” those which are starting to turn grey, are becoming dehydrated and then gradually the more grey the vertebral discs become they begin to lose height compared to others until the size or height of these discs really reduces, this is usually occurring in tandem with the boundaries of the disc being passed, i.e. the discs bulge out into the spinal canal, like a flat tyre. 

Is degenerative disc disease a sign of old age and just normal?

NO! This is one of the biggest frustrations that we’ve run into when it comes to degenerative disc disease. There are a couple of reasons for this, but let us start by saying that of course, the longer you have been living and using your body, the more likely you are to have built up sufficient strain on a particular part of the body to cause repetitive strain, injury and degeneration, but it is not a foregone conclusion. 

If degenerative disc disease was a function of age and age alone, as it is so often portrayed by what could be considered lazy healthcare professionals, the whole spine and all the joints would look the same.

If your practitioner or specialist is touting such a falsehood, it is worth seeing someone else instead, as they either lack the ability or effort, to provide a more true explanation. 

The most common discs that receive such a diagnosis are the L5, S1 and L4, L5 discs in the low back, these are the last two. If you’ve been following the podcast for any length of time, you’ll have a good idea why this might be, but in short. If you have been abusing this region of the body over time, it will begin to wear more. This is a process you have control over, although you might well have been abdicating responsibility for this unwittingly. That’s not your fault as you didn’t know any better. But a practitioner looking at your imaging and seeing that L5,S1 is significantly more degenerate than any of the other lumbar segments should immediately communicate this and seek to help educate you around why this might be the case and what to do going forwards. This is the sort of education we provide to our members in the Back In Shape Program.

To round this section off, an anecdote. As you likely know already we’ve worked with many thousands of patients and members over the years with imaging, frequently accompanied by additional radiologist reports for additional information. Frequently we would see the line “normal age related wear and tear” which could be considered synonymous with degenerative disc disease when referencing lumbar discs. The problem is that this phrase was used for people in their 20’s and in their 60’s, and when you compare the images side by side, they are fundamentally the same in appearance. 

That is to say that the spine of the 60 year old man and the 25 year old girl looked more or less the same in terms of degeneration in the discs, in this case not that bad at all, yet both had the same phrase “normal age related wear and tear”. This cannot possibly be the case! The statement consequently is useless, and the same enigma’s had occurred time and time again with the diagnosis of degenerative disc disease.

Factors that can affect the severity of a degenerative disc disease diagnosis

Ultimately the diagnosis itself could be considered one of degenerative changes within a disc, and as such there are a number of factors that can accelerate this process. Some are traumatic or injuries, others are less obvious, and it all comes back to the observation of our experience. The overwhelming majority of cases of degenerative disc disease diagnosis took place within a person’s spine who did not have whole spine degeneration. The degradation was present instead in one or two vertebral discs, even though all the discs in the person’s spine were the same age.

Injury to a disc kicks off the degenerative process

The human body is resilient and will regenerate well, most of us have moved in a peculiar way, slipped or otherwise injured something, it was sore for a moment, maybe a few days, and then recovered. This is the majority, however, sometimes we have more severe injuries and they can leave their mark if not rehabilitated properly. A severe accident that results in a profound disc herniation, for example, will compromise the disc structure, in a way that, although it may well heal well, if rehabilitation is not done correctly, this could result in the full health of the disc not returning.

Repetitive injury slowly degrading the health of the segment

As is more commonly the case these days, the consistent actions of sitting for extended periods, combined with smaller scale traumas which are never fully rehabilitated is the genesis of the vast majority of degenerative discs in the lower back. This is fundamentally the way we use our bodies and the lack of physical conditioning that allows for strain to focus at a target region of the body and “wear out” that area at a rate faster than it’s capacity for repair and regeneration. 

Just like the weathering of a stone, the water in a single drop of rain is never enough to compromise the stone, but the cumulative effect over the centuries creates the wear. Just like in our lower back, the isolated movements and occurrences are not problem enough to create compromise in such a marvellous structure, the human spine, but cumulatively over the years it becomes too much to bear for the target of such a torrent of abuse.

There will of course be additional factors such as diet that have an impact on our health as a whole and by extension our functioning as an organism but that will have to wait for another time, if you are interested in diet specifically, the episode on the best supplement for lower back pain is worth a browse.

The challenges that arise with degenerative discs in your lower back

Aside from the less than perfect functioning of the lumbar spine, the degenerative disc creates some inherent challenges. Discs are part of a wider intervertebral unit. This unit consists of the disc which acts as a cushion and spacer on the front, just behind it is the spinal cord in the spinal canal, and either side are the little tunnels out of which the spinal nerves leave to go on to form nerves such as the sciatic nerve in the lower lumbar spine. The discs height will dictate the distance that the two vertebrae are apart from one another, and by extension, the size of the space these nerves have to run through. Behind these the facet joints are located and between all the bones on the back part of the spinal segment, ligaments run to provide tension to the unit to keep the whole spine primed for movement. 

When the space on the front drops, the designed balance in this “unit” is affected, for example, the ligaments, are designed to run over a hypothetical distance of 1 cm at rest, if that distance is reduced to 0.8 cm then there will be “slack” in the ligaments. The easiest way to visualise this is an elastic band that is pulled and taught will be thinner than if the tension is eased a little. In combination with a reduced size of the hole where the nerves come out, this can further decrease the “space”.

Reduced exit foramina size associated with degenerative discs

This reduction in the exit foramina size, leads to one of the main challenges in those with degenerative disc disease in the lower back. That is that a comparatively insignificant aggravation of local tissues, i.e a relapse, will often lead to a disproportionate severity of symptoms as inflammation quickly fills the smaller space and puts pressure on the nerves that run through, leading to the back pain or sciatic symptoms.

Instability at the level of the degenerative disc

In the short to medium term, there is the additional challenge of the segmental unit not being as “primed” as all the other segments of the spine. This is akin to driving along with your seatbelt pulled loose, something that we are all told not to do as children, but why? It means that when you suddenly stop the car, you fly forward an inch or two, before your belt suddenly kicks in, creating a sharp local force as opposed to a more graduated deceleration. 

This sharp local force is what makes the unstable segment more vulnerable to flare ups, and combined with the previous issue mentioned above, makes for an explanation as to why it is more challenging for those with degenerative discs because of the wider implications on the segment as a whole.

What you must avoid if you have degenerative disc disease in your lower back

The challenge with this combination of factors, the smaller spaces and the instability, is that you will often feel the urge to stretch the lower back more, meaning, flatten the lower back and eliminate the lordosis. You do this because pressure more readily builds up from minor aggravations, as mentioned earlier. This forward bending movement also serves to open out the facet joints and stretch the ligaments on the back of the spine. This offers little in the way of support for the healing process and serves to prevent the natural “tightening up” process that is trying to occur to restore a degree of stability at this level. 

You will also often find that backward bending movements will be painful, such as the cobra. These will create shearing at the degenerate and unstable segment and be unpleasant, naturally it is all too easy for this to reinforce the need for the child’s pose stretch that’s flattening the low back and feels nice. However this stretch is only serving to continue to compress the disc and stretch the ligaments!

This is a trap! 

Instead you must focus on providing support for your neutral spine in the short to medium term and develop resilience to the spine being pulled out of line involuntarily. This is what we will get into in the closing section. 

Effective management and resolution for degenerative disc disease in the lower back

The first thing to acknowledge is the genesis of your degenerative disc, chances are that it has been there long before you actually had pain, something worth considering. Hopefully now you know that these “segments” or “vertebral units” are going to be more vulnerable if degenerative and so need a little care. Take a moment to consider the way you use your body on a daily basis, and how this will often be contributing to the focussed strain on this particular part of your lower back more than others. Make changes where necessary. For example, a sit-standing desk can go a long way to interfering with the cumulative strain that develops on the L5, S1 segment when sitting for 6 to 8 hours of your day. 

Start taking steps to learn how to move more effectively. If for example you are always rounding your lower back to bend, then getting onto the floor or bending with your knees and hips is a habit you need to develop. If you’re thinking that your knees are too bad for that then I would put it to you that your knees are bad because you’ve not been doing those sorts of movements and weaknesses developed over the years! Something to reflect on perhaps. This episode on how knee pain relates to lower back pain would certainly be worth your time.

Begin to engage with some proper resistance based exercises with good form to start to provide the stimulation and practice necessary to help the soft tissues of the segment and surrounding regions of your spine and hips adapt and strengthen. Where you have a greater degree of degenerative change in the low back discs you should work more diligently to get your hips stronger and more flexible to offset the inherent limitations that your lower back may have.

Finally, rid yourself of the third D, disease, this is not a disease, but it is something to take seriously. It is perhaps a warning, and a golden opportunity, to start taking your back health more seriously for the long term. With the right strategy, you can use this as an early warning sign that things are not as good as you thought they might be, and you can start making some real improvement in the health and strength of your lower back. This will often mean that the degeneration in that section of your lower back is no longer an issue for you on a day-to-day basis. As a general rule, there is no reason, with the proper rehabilitation and commitment to long term well being, that your low back needs to be a limiting factor in your daily life.

If you do want help with a program that can help get you there, complete with the support of our team throughout the journey, check out the Premium Membership. We’d love to welcome you to the program and help you get your Back In Shape, for good.