No one is exempt from aging. Many of us first become aware of our aging when we reach our thirties. There may be a new wrinkle on the skin or a gray hair showing in a dark head of hair, but these superficial characteristics are external warning signs of an aging process which affects the muscles, joints, and spine as well. More than just bothered by the toll of aging on one’s physical appearance, the spine weakens with age. At relatively young ages, women are dealing with osteoporosis – thinning of the bones – and commonly, degenerative disc disease (DDD).
Degenerative disc disease is not really a disease, but a term used to describe the normal changes of spinal discs as the aging process advances. Spinal discs are soft and compressible shock absorbers which cushion the bones of the spine. The discs allow the spine to flex, bend, and twist, absorbing the stresses of life and recreational activities, such as lifting weights or running marathons. This degenerative process, or DDD, takes place throughout the spine, but most often occurs in the discs of the lower back (lumbar region) and the neck (cervical region).
Many patients diagnosed with low back pain, caused by degenerative disc disease, are left wondering exactly what this diagnosis means for them. As we age, our intervertebral discs lose their flexibility, elasticity, and shock-absorbing characteristics. The discs lose water, which is essential for the collagen within the disc space to maintain flexibility. The ligaments which surround the disc space, the annulus fibrosis, become brittle and more easily torn. At the same time, the soft gel-like center of the disc, the nucleus pulposus, starts to thin and shrink. The combination of repetitive damage to the intervertebral disc, the development of bone spurs, and a gradual thickening of the ligaments that support the spine, all can contribute to degenerative arthritis.
Pain generally occurs near the location of the affected disc. An affected disc in the neck area may result in both neck and arm symptoms, while a disc in the lower back may result in pain in the back, buttock, or leg. The pain often becomes worse with movement, such as bending over, reaching up, or twisting and may start with a seemingly trivial injury. Most commonly, pain occurs with prolonged sitting or prolonged standing, such as on a long car trip or an airplane flight.
Degenerative disc disease is diagnosed after a thorough study of the patient, the medical record, and the result of a physical examination. Common questions involve symptoms, previous injuries or illnesses, any previous treatment, habits, and activities that may cause pain in the neck, arms, back, buttock, or legs.
When the presumptive diagnosis is degenerative disc disease, many people are first treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Exercise programs to strengthen abdominal and spinal musculature, improvement of aerobic fitness, and reducing lumbar lordosis are often necessary to alleviate the symptoms. Corticosteroid injections are offered only after physical therapy, rest, and medications have failed to adequately relieve the symptoms of pain, numbness, or weakness. Further treatment, such as surgery, depends on whether the damaged disc has worsened into osteoarthritis, a herniated disc, or spinal stenosis causing compression of the traversing nerve roots within the canal.
Realize that degeneration or degenerative arthritis in the spine is as certain as death or taxes; however, we need not be held prisoner to the fear of aging. Maintaining a healthy body weight, aerobic fitness, core muscular strength, and a well-balanced diet will all contribute to combating this natural aging process. We can still live active and vigorous lives as we grow older, calling on our healthcare providers to help us avoid illness or reduce pain when necessary. Indeed, we would do well to accept these changes, not deny them.