What is Degenerative Disc Disease?
The neck is comprised of vertebrae (spinal bones) and in between each spinal bone is a cushioning disc. Degenerative disc disease (DDD) refers to process of natural wear and tear of these intervertebral discs. DDD is a common condition in the neck that has the potential to lead to neck pain, neck stiffness and radiating arm pain when nerve irritation exists. It is important to note that the existence of DDD does not always result in symptoms. Many individuals who present with DDD on MRI are actually asymptomatic.
General Anatomy of the Disc and the Natural Progression of Change
Each disc has an tough, fibrotic outer portion called the annulus fibrosis and a more gel like, fluid inner portion called the nucleus pulposes. The nucleus pulposes is what contributes to the shock absorbing function of the disc. Before the age of 20, the water content in the disc is very high. After 20 years of age, as a result of the aging process, water content diminishes. As the disc loses water content and “dries out” it becomes susceptible to cracks and tears. The disc does not have a direct blood supply and instead receives it blood supply and nutrients through diffusion from the end plates (found at the attachment of the adjacent vertebra). As such, the healing capacity of the disc is decreased and even when healing does occur, the disc is weaker and is susceptible to damage more easily in the future.
What Causes Degenerative Disc Disease of the Cervical Spine?
Genetics is thought to play a role however, a traumatic neck injury or postural dysfunction has the ability to instigate or speed up the wear and tear process.
Wear and tear will tend to develop more rapidly in areas of the spine that are subject to increased load, pressure and strain.
With age, degeneration of the discs is to be expected. DDD is like wrinkles in our spine.
What Can Be Done for Degenerative Disc Disease in the Neck?
If you experience symptoms relating to DDD then there are many conservative options to management that have proven to be effective.
- Posture Re-Education-To improve alignment of the spine and decrease strain on the discs.
- Corrective Exercise-To improve muscle imbalances and posture as well as improving activation of the musculature that stabilizes and supports the spine.
- Manual and Manipulative Therapies-Hands on therapies to improve mobility of the intervertebral joints and soft tissue surroundings to improve joint and muscle function.
- Lifestyle Modification and Ergonomic Corrections-To decrease the strain that can be placed on the neck and discs of the neck to prevent injury and aggravation.
- Acupuncture and Gunn IMS-To decrease pain, improve nerve and local muscle function and reduce compression of the joint due to taut bands of muscles.
- Anti-inflammatory Medications-To decrease local inflammation which can be a source of pain.
- Injection therapies-Various injections can be used to decrease inflammation, promote healing or block nerves which contribute to pain.
- Surgical management-Only to be considered in severe cases where conservative management is not successful.
A qualified physiotherapist or chiropractor can assist you with a conservative management plan that is individualized to your specific needs and targets your goals. If you require further medical management, your physiotherapist or chiropractor will refer you to a specialist who will be able to help you evaluate other treatment options. It’s always best to exhaust all conservative options first as the outcomes are excellent and the majority of people with symptoms of DDD will respond positively.
Can You Cure Degenerative Disc Disease?
DDD occurs as part of the natural aging process. As such, there is nothing abnormal about the process. The process of aging is not a disease and in our opinion, the terminology referring to this condition as a “disease” is an inaccurate representation.
The good news is that conservative management is generally very successful at reducing the symptoms associated with DDD. The symptoms of DDD often flare up when there is undue strain, load or pressure affecting the specific discs or aspect of the neck. These symptoms will typically settle and/or your discs will adapt to accommodate the load within weeks or months so that the symptoms are once again under control. Treatment received from a trusted physiotherapist or chiropractor can help expedite the recovery/adaptation and can give you the required tools to prevent future occurrences.
How Can You Stop Degenerative Disc Disease?
You cannot stop DDD for the same reasons as discussed above. However, you can slow the advancement of DDD if you follow some of the suggestions below:
- Ensure you have a healthy, well balanced diet
- Do not smoke
- Ensure that you are getting enough water in your diet
- Work on your posture
- Avoid unnecessary and excessive compressive load through your spine (aggressive weight lifting and/or activities that your musculoskeletal system is not conditioned to)
- Lead an active lifestyle
- Get the right treatment if you injure your neck, back or shoulders
Exercises for Degenerative Disc Disease?
A well-rounded program should consist of neck range of motion, neck and shoulder stabilization and strength as well as postural re-education geared at the muscles of the neck, back and shoulders. Ideally, these exercises should be individualized to your particular needs and goals through physiotherapy or chiropractic care.
If you are symptomatic, exercises should be gentle and should stay within your pain free limits. General exercises to choose during this phase include:
- Gentle chin tucks (while lengthening the spine)
- Deep neck flexor activation
- Gentle range of motion (ROM) exercises of the neck, shoulder girdle and thoracic spine
- Gentle stretching of the neck, upper back and shoulder musculature
- Scapular stabilization exercises
If you are non-symptomatic and you have mastered some of the basic exercises above then you can move on to more advanced exercises:
- Progression of neck stabilization and deep neck flexors
- Progression of scapular stabilization
- Upper back strengthening
- Rotator cuff strengthening
- Full body functional movements that target the core and spinal alignment such as planks, push ups, pull ups, shoulder press etc.
Contact us today if you would like one of our trusted physiotherapists or chiropractors to advise you on sets, reps and holding times for the above exercises. They can also ensure you have correct form and are not compensating due to weakness. Your program will be individualized based on your examination findings and will deliver the best results.