Pain Conditions Treated

Degenerative Disk Disease

Bay State Pain Management Has Expert Pain Management Doctors & Medical Staff Who Provide Effective Treatments for a Wide Range of Conditions, Including Degenerated Disc Disease, Spine Pain and Radiculopathy, Spinal Stenosis, and Spinal Fractures.

Degenerative Disk Disease

  • Overview
  • What Is it?
  • Diagnosis
  • Causes
  • Common Symptoms
  • Treatment Guidelines
  • Surgical Treatments

Degenerative disc disease is a condition that is commonly misunderstood. A degenerated disc is not actually a disease—it is part of the normal aging of the spine. When a spinal disc degenerates, it loses its ability to function efficiently as part of the spinal joint, which in turn can lead to back pain and possibly pain that radiates through the extremities.

Degenerative disc disease

Degenerative disc disease describes a group of symptoms that may result from the gradual wear and tear of spinal discs or from an acute spinal injury. 

Degenerated disc disease is typically associated with aging. As you age, your discs can degenerate and become problematic. Degenerative disc disease involves the intervertebral discs, which is the cushion between your vertebrae in your spine. They help your back carry weight and allow complex motions of the spine while maintaining its stability.

As you age, the discs can lose flexibility, elasticity, and shock absorbing characteristics. They also become thinner as they dehydrate. When all that happens, the discs change from a supple state that allows fluid movement to a stiff and rigid state that restricts your movement and causes pain. Developing degenerative disc disease is a gradual process. Although most degenerative disc disease patients respond well to non-surgical treatments, such as cortisone injections, some patients do need surgery. Surgery should be considered only after you’ve tried several months of non-surgical treatment

Diagnosing Degenerative Disc Disease

 

The following process is typically used to diagnose degenerative disc disease:

  • A medical history is collected that details current and past symptoms of neck or back pain, including when the pain started, how often pain occurs, where pain is felt, and the severity of pain and its impact on mobility. A medical history may also include information on sleep and dietary habits, exercise and activity level, and how symptoms are eased or worsened by activity or posture.
  • A physical exam is conducted, which may include feeling along the spine for abnormalities (palpation), a reflex test, and/or a range of motion test that includes bending the spine forward, backward, or to the side.
  • An imaging test may be ordered in some cases to find or confirm disc degeneration in the spinal column. An MRI scan is usually used for suspected disc degeneration, which can show disc dehydration, tears or fissures in the disc, or a herniated disc. A dehydrated disc may be referred to as a dark disc or black disc, because it looks darker on an MRI scan.

     

It is important to note that the amount of pain does not correlate to the amount of disc degeneration. Severely degenerated discs may not produce much pain at all, and discs with little degeneration can produce severe pain—a handful of studies have found prevalent disc degeneration in people not experiencing any disc pain.

For this reason, a diagnosis of degenerative disc disease should always rely on a combination of a medical history, a physical exam, and any imaging tests ordered.

As a final note, it is helpful for patients to know that the amount of pain does not correlate to the amount of damage in the spine. Severely degenerated discs may not produce much pain at all, and discs with little degeneration can produce severe pain. What this means for patients is that even if they are experiencing severe pain, it does not necessarily mean that there is something seriously wrong with their spine and does not necessarily mean that they need surgery to repair any damage.

A degenerating spinal disc does not always lead to pain or other symptoms. Because the disc itself has very little innervation, pain usually occurs when the degenerating disc affects other structures in the spine (such as muscles, joint, or nerve roots).

Pain associated with degenerative disc disease generally stems from two main factors:

  1. Inflammation. Inflammatory proteins from the disc space interior can leak out as the disc degenerates, causing swelling in the surrounding spinal structures. This inflammation can produce muscle tension, muscle spasms, and local tenderness in the back or neck. If a nerve root becomes inflamed, pain and numbness may radiate into the arm and shoulder (called a cervical radiculopathy in cases of cervical disc degeneration), or into the hips or leg (called a lumbar radiculopathy, in cases of lumbar disc degeneration).
  2. Abnormal micro-motion instability. The cushioning and support a disc typically provides decreases as the disc’s outer layer (the annulus fibrosis) degenerates, leading to small, unnatural motions between vertebrae. These micro-motions can cause tension and irritation in the surrounding muscles, joints, and/or nerve roots as the spinal segment becomes progressively more unstable, causing intermittent episodes of more intense pain.

Both inflammation and micro-motion instability can cause lower back or neck muscle spasms. The muscle spasm is the body's attempt to stabilize the spine. Muscle tension and spasms can be quite painful, and are thought to cause the flare-ups of intense pain associated with degenerative disc disease.

What Happens in The Spine During Disc Degeneration?

Degenerative disc disease primarily concerns a spinal disc, but will most likely impact other parts of the spine as well. The two findings most correlated with a painful disc are:

  • Cartilaginous Endplate Erosion. Like other joints in the body, each vertebral segment is a joint that has cartilage in it. In between a spinal disc and each vertebral body is a layer of cartilage known as the endplate. The endplate sandwiches the spinal disc and acts as a gatekeeper for oxygen and nutrients entering and leaving the disc. As the disc wears down and the endplate begins to erode, this flow of nutrition is compromised, which can hasten disc degeneration. As the disc goes through this process, the disc space will collapse.
  • Disc space collapse. As a disc degenerates the disc space will collapse, placing undue strain on the surrounding muscles as they support the spine and shortening the space between vertebrae, leading to additional micro-motion and spinal instability.
 

The degenerative processes typically progress gradually rather than all at once. Endplate erosion and disc space collapse can add to spinal instability, tension in the surrounding muscles, and both local and nerve root pain.

What Are the Symptoms?

You'll probably feel a sharp or constant pain in your back and neck. Your exact symptoms depend on where the weak disk is and other changes it has caused.

Common signs include pain that:

  • Is in your lower back, buttocks, or upper thighs
  • Comes and goes. It can be nagging or severe, and can last from a few days to a few months.
  • Feels worse when you sit, and better when you move and walk
  • Feels worse when you bend, lift, or twist
  • Gets better when you change positions or lie down
  • In some cases, degenerative disk disease can lead to numbness and tingling in your arms and legs. It can also cause your leg muscles to become weak. This means the damaged disks may be affecting the nerves near your spine.

Degenerative disc disease is frequently the cause of low back pain, especially in young adults.

Although this condition can cause lower back pain symptoms over a long period of time, the good news is that the pain is usually manageable with various conservative treatment options (meaning back care that doesn't involve surgery).

 

Low Back Pain and Degenerative Disc Disease Treatment Goals

The vast majority of people with degenerative disc disease experience low back pain symptoms that flare up periodically, but don't get worse over time. For those people, the main goals for managing lower back pain caused by degenerative disc disease are usually:

  • Achieving enough pain relief to be able to engage in lower back pain exercises and a rehabilitation program
  • Preventing the application of excess stress on the disc through proper ergonomics and posture
  • Trying to manage the low back pain and maintaining an ability to function enough at home and at work.

Most types of surgery for ongoing, debilitating pain and loss of function from degenerative disc disease are fairly extensive, so it is usually in the best interest of most patients to manage their low back pain using non-surgical approaches and self-care. Over time, the low back pain and other symptoms of degenerative disc disease will usually subside. This happens because the disc starts to become stiffer with age, and a stiffer disc stabilizes the motion segment and thus reduces pain. However, this is a very slow process that occurs over many years.

Lower Back Pain Treatment for Degenerative Disc Disease

Pain from degenerative disc disease is caused by a combination of instability at the motion segment and inflammation from the degenerated discs. Both the instability and the inflammation have to be addressed for the back pain treatment to be effective.

The treatments for degenerative disc disease are either passive (done to the patient) or active (done by the patient). Usually, a combination of treatments is used to help control the symptoms. Passive treatments are rarely effective on their own—some active component, such as exercise, is almost always required.

Passive treatments for low back pain from degenerative disc disease may include:

  • Pain medication. Typical pain medications used to treat the low back pain include acetaminophen, NSAIDs, oral steroids, narcotic drugs, and muscle relaxants. Each type of medication has strengths, limitations, and risks, and the patient's particular low back problem and overall health will determine which pain reliever, if any, is indicated.
  • Chiropractic manipulation. Manual manipulation by a chiropractor or other qualified health professional is thought to provide lower back pain relief by taking pressure off sensitive neurological tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and creating a series of chemical reactions in the body (such as endorphin release) that act as natural painkillers.
  • Epidural injections. An epidural injection into the spine delivers steroids that can provide low back pain relief by decreasing inflammation in the painful area.
  • TENS units. These devices deliver mild electrical stimulation that overrides the painful signals sent to the lower back.
  • Ultrasound. For acute back pain in the low back, ultrasound may be used to warm the area, which in turn brings blood flow and healing nutrients to the area.
  • Massage. Therapeutic low back massage is thought to provide low back pain relief by improving blood flow, reducing muscle stiffness, increasing range of motion, and raising endorphin levels in the body.

     

In addition, heat and/or ice therapy, acupuncture, behavioral therapy, and other therapies often provide enough low back pain relief to allow the patient to progress with his or her exercise and rehabilitation program.

Active Lower Back Pain Treatments

Some active treatments for lower back pain can include:

  • Exercise. For the vast majority of patients, the only way to achieve long-term healing is active exercise, which usually includes a combination of strengthening, stretching and low-impact aerobic exercise.
  • Quitting smoking. For patients who smoke, doctors recommend quitting smoking to improve blood circulation and healing. Chronic tobacco use is closely linked to chronic pain in the lower back.
  • Weight loss. Losing weight can reduce low back pain in overweight people by lessening the amount of stress on the low back's muscles and ligaments.
  • Ergonomics. Proper lifting techniques, ergonomic furniture, supportive footwear, and avoiding static posture for prolonged periods of time can help take pressure off the low back.

Degenerated Disc Disease Treatment: Why Choose Bay State Pain Associates

  • Our pain specialists use high-precision diagnostic techniques that allow them to identify the location and degree of disc degeneration with high accuracy.
  • Cervical, lumbar and thoracic degenerative disc disease, as well as bulging and herniated discs, are some of the disc-related conditions our specialists are experienced in treating.
  • If you are a candidate for nonsurgical or minimally invasive spine treatment, our experts will try these approaches first before considering surgery for degenerative disc disease.
  • Skilled in complex spine revision surgeries, our specialists also work with patients who had prior spine surgery that didn’t resolve their pain.
  • If degenerative disc disease leads to or worsens spinal stenosis, or radiculopathy, our pain experts can help address these conditions as well.

Treatment for degenerative disc disease typically starts with nonsurgical methods that may provide sufficient symptom relief. When you request an appointment with one of our pain specialists, he will carefully examine you and your MRI scans to determine which treatment approach will best meet your health goals.

 

Nonsurgical Treatment

  • Pain control focuses on reducing pain from the damaged disc and helping you return to your daily activities. Methods of pain control may include anti-inflammatory medications, manual manipulation, steroid injections, electrical stimulation, back braces or heat/ice therapy.
  • Physical therapy can help stretch and strengthen the right muscles to help the back heal and reduce the frequency of painful flare-ups.
  • Lifestyle modifications, such as changing your posture, losing weight or giving up smoking, can sometimes help reduce stress on the damaged disc and slow down further degeneration.

 

 

Surgical Options

Surgical options are available for people who experience severe pain or significant loss of function and don’t respond to other treatments. The surgery may involve removal and replacement of the whole or a part of the affected disc (partial or total disc replacement). Another option is disc removal (discectomy) with spinal fusion that reduces the movement in the damaged spine segment.

Surgery to address degenerative disc disease is usually only recommended if pain is severe and nonsurgical treatments, such as pain medications and physical therapy, are ineffective. The goal of surgery is to alter the underlying mechanisms in the spine causing pain, such as excessive micro-motion, inflammation, and/or muscle tension. 

Prior to deciding whether to have surgery for degenerative disc disease, patients should consider the risks and benefits. 

Nonsurgical treatments are typically suggested for no less than 6 to 12 weeks before surgery is considered, although in most cases nonsurgical treatments are used for much longer. It is estimated that only between 10% and 20% of lumbar disc degeneration cases and up to 30% of cervical disc degeneration cases are not successfully treated using nonsurgical methods, and warrant surgery to relieve pain and improve mobility.

There are several factors to consider before opting for surgical treatment if it is recommended, including:

  • Recovery process. The recovery period following spinal surgery can consist of a combination of physical therapy, pain medications, or wearing a back or neck brace
  • Lifestyle considerations. The everyday lifestyle changes needed for either nonsurgical or surgical treatment may be considerable. In the case of surgery, a long recovery process may require significant time off from work. Additionally, regular physical therapy, and pain management will be required for optimal results.
  • Imaging evidence of disc degeneration. Spinal surgery for degenerative disc pain is typically only recommended if an imaging scan correlates to the specific cause of pain, and even then outcomes are not always predictable.

Spinal surgery is always elective, meaning it is the patient’s choice whether or not to have the procedure. A spinal fusion is the most common procedure used for degenerative disc pain. In recent years, artificial disc replacement has become more widely used as devices and surgical methods have improved.

Spinal Fusion for Degenerative Disc Disease

During a spinal fusion surgery, two adjacent vertebrae are grafted together to alter the underlying mechanisms causing pain. A fused joint eliminates instability at a spinal segment, reducing pain caused by micro-motions, muscle tension, and/or inflammation. Joint fusion can also allow for a more thorough decompression of pinched nerves.

A spinal fusion procedure typically consists of the following steps:

  • Under general anesthesia, an incision is made to approach the spine. For a cervical fusion, the incision is usually made in the front of the neck. For a lumbar fusion, an incision may be made in the back, front, or side of the body.
  • Muscles surrounding the spine are cut away or pushed to the sides to access the spine.
  • The degenerating disc is removed from the disc space.
  • A bone graft and/or instruments are implanted across the disc space to stabilize the spinal segment and encourage bone growth.
  • The spinal muscles are replaced or reattached, and the incision site is closed with sutures.

A fusion surgery sets up the mechanisms for bone growth, and the fusion occurs in the months following the procedure. For this reason, the complete recovery process from a fusion surgery can last up to a year, although a majority of patients are back to their regular activities within six weeks.

Following surgery, use of a back or neck brace may be advised to keep the spine stabilized and to minimize painful movements that can undermine the healing process. Additionally, physical therapy is usually recommended to condition the muscles to better support the spine, and pain medications are prescribed to manage post-surgical pain.

Artificial Disc Replacement Surgery

Degenerative disc pain can also be significantly reduced or eliminated by implanting a device that mimics the natural support and motion of a spinal disc in a procedure called Artificial Disc Replacement (ADR). Unlike a spinal fusion, this procedure is intended to maintain motion at a spinal segment after surgery.

In this procedure:

  • The spine is approached through a small incision under general anesthesia. During a cervical ADR, the incision is usually made in the front of the neck; during a lumbar ADR, the incision is usually made in the back directly over the spine.
  • The muscles are moved to the side or cut away from the spine.
  • The degenerated disc is removed entirely, as is any degenerated portions of the spinal joints or adjacent vertebrae in the disc space.
  • The artificial disc is inserted into the disc space using x-ray imaging to guide the device. Some devices also include metal plates that are attached to either vertebrae facing the disc space.
  • The muscles surrounding the spine are reattached, and the wound is closed.

Artificial discs are typically made of metal or plastic materials. The recovery process from an artificial disc replacement usually consists of a combination of pain medications, physical therapy, and possibly wearing a back or neck brace. Recovery from this procedure can take up to 6 months.

  • Controlling Degenerative Disc Disease Pain: Three Things You Can Do
  • Step Two of DDD Management: Reduce Lower Back Stress
  • Step Three of DDD Management: Improve Nutrition

Degenerative disc disease is a difficult condition to live with. However, it does not need to hinder the rest of your life.

Here are three things you can do to control your disc degeneration:

Step One: Stay active to slow the disc degeneration

Once pain is adequately controlled (it will most likely not go away completely) the most important thing patients can do is stay active.

Exercises not only preserve what functionality exists; they are the single best way of healing the back. Exercise increases the flow of blood and oxygen and other nutrients to the back and discs, thereby keeping them hydrated and as pliable as possible. Exercise can also improve one's sense of well-being by promoting the release of endorphins, a natural pain-reliever and stress reducer.

Staying active does not require a lot of innovation, but it does require planning, such as:

Strengthening and Aerobic Conditioning

Alternating 30 minutes of strengthening exercises with low-impact exercise like walking, biking or swimming every other day can maintain flexibility and mobility, as well as control weight. For those who are in too much pain to tolerate much exercise, a gentle approach is best. Water therapy is particularly gentle on the lower back, as the water provides support for the weight of the body.

Stretching

Doing five minutes of stretches first thing in the morning and the last thing before bed will also significantly increase mobility. Hamstring stretching is almost always important for patients with lower back pain. Additional, more targeted stretching, such as piriformis stretches, may be advisable, depending on the patient’s diagnosis.

Investing in a few hour-long sessions with a physical therapist or certified athletic trainer knowledgeable about low back pain can provide adequate guidance and ideas for back exercises that can be done with and without exercise equipment.

The corollary to undertaking productive activity is stopping destructive activity, and there are many opportunities throughout the day to modify common actions that can hurt a degenerated disc, such as:

  • Correcting posture and using low back support. Degenerated discs are frequently more painful when an individual is sitting, especially if he or she is slumped forward putting more pressure on the lower back. Sitting upright in an ergonomic chair that provides low back support for the natural curve in the lumbar region can prevent irritating discs. Hanging a small mirror near their desk can allow patients to check posture and remind them to straighten up.
  • Changing position often to relieve stress and increase blood flow. Just standing and walking 10 paces every 20 or 30 minutes is enough to prevent low back stiffness from setting in.
  • Lifting heavy objects correctly. This involves holding the object close to the body, engaging the large quadriceps muscles in the thighs and placing the object by pivoting the feet, not twisting the back or torso. Leaning over from the waist should be avoided.
  • Finally, sleeping on a comfortable, supportive mattress can make the difference between waking up refreshed and waking up stiff and sore. There are many mattresses designed to provide support to the natural curves of the back, and patients should choose the type of mattress they feel most comfortable in to help them sleep soundly at night.

    See Choosing the Best Mattress for Lower Back Pain



The health of one's spine reflects the overall health of the body, and a healthy diet plays a role in moderating the low back pain of degenerative disc disease. Specifically, intervertebral discs benefit from:

  • Hydration
  • Oxygenation

Patients can achieve both hydration and oxygenation with small changes, such as:

  • Hydration can be improved by sipping water throughout the day, especially during and after exercise, as well as eliminating or reducing use of caffeinated drinks such as coffee, some teas, and soda.
  • Alcohol use should be minimized. Alcohol not only decreases hydration, it is a depressant. Using alcohol to self-medicate and numb pain can start a cycle of unhealthy actions, interfering with everything from sleep quality, the ability to make healthy food choices, and the motivation to exercise.
  • Smoking – or any nicotine intake - should be eliminated, because it interferes with nutrition for the spinal discs by preventing the good oxygen flow needed to keep them healthy.

Although the term degenerative disc disease sounds fearsome, for most people the low back pain and other symptoms from lumbar degenerative disc disease can be managed quite effectively with self-care.

By making a concerted effort at managing the pain, most patients will find that they can keep the pain to a tolerable level and continue to enjoy their favorite activities without having to undergo major surgery.

  • Living with Degenerative Disc Disease
  • How to Lessen Pain from a Degenerated Disc
  • Treatment for Degenerative Disc Disease

Living with Degenerative Disc Disease

The vast majority of people with lower back pain and/or sciatica symptoms from lumbar degenerative disc disease will be able to successfully manage their pain and avoid surgery. Indeed, over 90% of individuals specifically diagnosed with degenerative disc disease will find that their low back pain and other symptoms go away or subside within three months.

But even patients whose pain does not subside within three months can undertake a range of actions—including a number of self-care activities—to manage their pain.

This article identifies the key components of a self-care program patients can undertake to manage the pain of degenerative disc disease, and describes actions that can be incorporated into daily routines, including:

  • First, quickly reduce the pain to a tolerable level
  • Engage in a controlled, progressive exercise and active rehabilitation
  • Identify and act on any behavioral and activity modifications needed to minimize aggravation to the disc
  • Improve hydration and nutrition to foster improved spinal disc health
 

What you need to know about DDD Pain

What many patients don’t know is that degenerative disc disease pain in the vast majority of cases is often manageable through self care and some nonsurgical treatments.

Here are several insights about degenerative disc disease that will help patients navigate their treatment options and play an active role in minimizing their pain:

  • Degenerative disc disease pain does not tend to progress with age. While the discs will often continue to degenerate, the associated pain tends to subside. Generally by age 60 a degenerated disc will have stabilized and will usually not be painful.
  • The typical symptom profile is that pain increases at times with a painful flare-up that can last several days, weeks, or even a few months, but then usually subsides back to a lower, more tolerable level.
  • The surgery to address degenerative disc disease is typically a spinal fusion, which is a major surgery and changes the anatomy of the back by fusing a motion segment together into one long bone.

     

Consequently, the goal for patients living with degenerative disc disease should be to do what they can to proactively manage their painful flare-ups and reduce the incidence and severity of flare-ups. This focus will, in turn, provide the best chance for patients to maintain their ability to function in everyday activities, if possible avoid major surgery.

Before taking steps for long-term rehabilitation and pain control, it is often necessary for a patient to get relief from a flare-up of intense, debilitating pain associated with lumbar degenerative disc disease.

Once the pain is under control and reduced to a more tolerable level, patients can then perform everyday activities and engage in active physical therapy and exercise to improve the longer-term course of degenerative disc disease.

Quick steps to control pain include:

Ice Application

Applying ice to muscles that are painful after activity or exercise will help control pain and inflammation. Using ice packs on the lower back for 10 minutes can be a cost-effective, easy approach to take at home. Having ready-made packs in the freezer will allow patients to grab one quickly when needed.

Heat Application

Alternatively, a heating pad or moist heat compresses (a moistened towel warmed in a microwave is easy to make) can relax muscles or joints around the degenerated disc that have tightened up. Applying heat will warm up the lower back muscles, make stretching and exercise easier and decreasing the chance of injury.

Over-the-Counter Medication

Taking over-the-counter medication such as NSAIDs (non-steroidal anti-inflammatory drugs, e.g. Advil or Motrin) can decrease the inflammation around the degenerated disc. Pain can also be treated with acetaminophen pain relievers such as Tylenol.

For pain that doesn't respond to over-the-counter medications and home remedies, stronger anti-inflammatory medications can be prescribed (such as COX-2 inhibitors) or administered directly into the low back (e.g., epidural injections) for pain relief.

Patients can also take advantage of alternative therapies like massage therapy, acupuncture or chiropractic manipulation to relieve tightness and decrease pain. Often patients will find that a combination of therapies works well, such as spinal manipulation, NSAIDs, massage therapy, and ice and heat.

Once the pain is at a tolerable level, patients then have a lot of options in terms of what they can personally do to prevent and/or minimize future flare-ups of degenerative disc related pain.

Degenerative disc disease in the spine is basically wear and tear of the discs. As we get older, the water, the hydration within the discs tends to leave and you end up with a drier disc.

Now, degenerative discs don't necessarily cause any pain. It’s very common to get an MRI and see degenerative discs that are totally asymptomatic. When discs cause pain, it’s because there’s a tear inside of the disc and the inflammatory proteins on the inside of the disc have oozed out and they’re irritating the outer third of the crust of the disc where there are nerve fibers.

When degenerative disc disease is causing axial lower back pain, the treatment approach generally focuses on taking away the inflammation from around the disc and stretching and strengthening the appropriate muscles through exercise, through physical therapy, to help take the pressure off of the disc so that the pain doesn't return. Often that starts with exercise, with physical therapy, with stretching and strengthening, and getting all the mechanics right with posture to unload the spine to take the pressure off to allow the disc to, essentially, heal.

There are some other modalities along the way. Oral medications can help control the pain, allow a person to continue with physical therapy. Within physical therapy, there are other modalities, passive modalities like TENS units, and ultrasound, and manual manipulations, and massage to help control the symptoms and also, in a smaller way, to help take away the inflammation from around the disc.

When symptoms are persistent despite these exercise physical therapy modalities, or if the pain is getting in the way of a person actually participating with the exercises, then there are other modalities, such as injections, to help take away the inflammation from around the disc, typically through an epidural steroid injection.

An epidural steroid injection is not going to fix a disc. It’s not going to put hydration back into the disc, nor will it necessarily change, nor will it change the tear within the disc. But it will do is it'll reset the inflammatory clock back down to zero. And what this does is it allows a person to take advantage of this window of opportunity, during which they can do more with the physical therapy. They can tweak the biomechanics so that, ideally, the inflammation doesn't return because the same stresses aren't going through the disc.

In rare instances. when discs aren't responding to more conservative measures and the pain is just persisting and it's interfering with quality of life, it’s certainly appropriate to have a conversation with a spinal surgeon about surgical alternatives.

Cervical Degenerative Disc Disease

  • Cervical Degenerative Disc Disease
  • Overview
  • Symptoms and Diagnosis
  • Causes
  • Treatment Guidelines

Cervical-degenerative discCervical degenerative disc disease is a common cause of neck pain and radiating arm pain. It develops when one or more of the cushioning discs in the cervical spine starts to break down due to wear and tear.

Cervical degenerative disc disease is diagnosed when a damaged disc in the spine becomes symptomatic.
 

There may be a genetic component that predisposes some people to more rapid wear. Injury may also accelerate and sometimes cause the development of the degenerative changes.

How Cervical Discs Can Degenerate

Normally, there are six gel-like cervical discs (one between each of the cervical spine’s vertebrae) that absorb shock and prevent vertebral bones from rubbing against each other while the neck moves.

Each disc is comprised of a tough but flexible outer layer of woven cartilage strands, called the annulus fibrosus. Sealed inside the annulus fibrosus is a soft interior filled with a mucoprotein gel called the nucleus pulposus. The nucleus gives the disc its shock absorption property.

In children, the discs are about 85% water. The discs begin to naturally lose hydration during the aging process. Some estimates have the disc’s water content typically falling to 70% by age 70, but in some people the disc can lose hydration much more quickly.

As the disc loses hydration, it offers less cushioning and becomes more prone to cracks and tears. The disc is not able to truly repair itself because it does not have a direct blood supply (instead getting nutrients and metabolites via diffusion with adjacent vertebrae through the cartilaginous endplates). As such, a tear in the disc either will not heal or will develop weaker scar tissue that has potential to break again.

The Course of Cervical Degenerative Disc Disease

Cervical degenerative disc disease is not technically a disease, but rather a description of the degenerative process that discs located in the cervical spine go through. Essentially all people who live long enough will develop degenerated discs.

Studies show that a plurality of adults have no symptoms related to degenerative disc disease, even though a high percentage of these adults still shows signs of disc degeneration on an MRI somewhere on the spine. One study found that about half of people start showing some signs of disc degeneration on an MRI by their early 20s.  Another study found that about 75% of people under age 50 have disc degeneration while more than 90% of people over age 50 have it.

When degenerative disc disease develops in the cervical spine, it can occur in any of the cervical discs but is slightly more likely to occur at the C5-C6 level.

In cases where cervical degenerative disc disease does cause pain, it can happen in various ways. In some instances, the disc itself can become painful. People are more likely to experience this type of discogenic pain in their 30s, 40s, or 50s.

When symptoms from cervical degenerative disc disease become chronic, the pain and/or symptoms are likely related to conditions associated with disc degeneration, such as a herniated disc, osteoarthritis, or spinal stenosis. Depending on the cause, the pain may be temporary, or may become chronic. To give an example, pain from a herniated disc is likely to eventually go away on its own, but pain from osteoarthritis may require treatment on a chronic basis.

While nearly everyone eventually gets cervical degenerative disc disease with age, there are some factors that can make it more likely to develop sooner and/or become symptomatic. These risk factors could include:

  • Genetics. Some studies of twins indicate genetics play a bigger role than lifestyle in determining when cervical degenerative disc disease develops and if it becomes painful.
  • Obesity. Weight has been linked to risk for developing degenerative disc disease.

    See Nutrition and Diet for Weight Loss

  • Smoking. This habit can hinder nutrients from reaching the discs and cause them to lose hydration more quickly.

     

In addition, an injury to the spine, such as a herniated disc, can sometimes start or accelerate cervical degenerative disc disease.

 

Cervical degenerative disc disease is diagnosed when a damaged disc in the spine becomes symptomatic.

A cervical spinal disc is a piece of soft tissue that is an essential part of each motion segment in the neck.

The strong, fibrous outer portion of a spinal disc, called the annulus fibrosus, wraps around the jellylike inner core of the disc, the nucleus pulposus.

The disc is prone to degeneration over time, in which the inner core of the disc loses hydration and becomes less pliable. The disc loses height, and the outer annulus fibrosis weakens, bulges, and develops tears.

Degenerative disc disease is thought to cause pain in multiple ways.

It is thought that as the degenerated disc loses its height and pliability, pain may be caused by abnormal micromotion in the vertebral segment.

The degenerating disc itself may become a source of pain, as the inflammatory proteins from the inner core of the disc may affect nerve fibers in the outer annulus.

In some cases, the disc space may collapse enough to compress a nearby nerve root, leading to radiating arm pain known as cervical radiculopathy.

Neck pain from degenerative disc disease often goes away over a long period of time as inflammatory proteins eventually subside and the disc collapses into a more stable position.

Pain from cervical degenerative disc disease is usually felt as a stiff neck, but it can also radiate into the shoulders, arms, hands, and fingers, depending on which nerves are being compressed or irritated.

Symptoms of cervical degenerative disc disease can vary widely from person to person.

When cervical degenerative disc disease becomes symptomatic, the pain might develop slowly over time or appear suddenly. The symptoms can range from mildly annoying neck discomfort to debilitating pain, numbness, and/or weakness that radiates into the arm and hand.

Some common characteristics of cervical DDD symptoms include:

  • Neck pain. The low-grade pain of a stiff neck is the most common symptom of cervical degenerative disc disease. However, sometimes the pain could also flare up and become severe, perhaps lasting a few hours or days.
  • Nerve pain. This type of pain tends to be sharp or electric shock-like and can radiate down the shoulder into the arm, hand, and/or fingers. Typically, nerve pain would only be felt on one side of the body.
  • Neurological symptoms in the arm, hand, and/or fingers. Pins-and-needles tingling, numbness, and/or weakness can radiate down the shoulder into the arm, hand, and/or fingers. These types of symptoms can interfere with daily activities, such as typing, getting dressed, or holding objects.
  • Pain gets worse with movement. In general, pain caused by the degenerative disc itself tends to be aggravated by movement and alleviated by rest.

If the pain comes from the degenerative disc itself, then it will likely go away on its own within a few weeks or months. However, other symptoms of cervical degenerative disc disease are more likely to become chronic and require treatment if facet joints in the neck also start to degenerate and/or a spinal nerve becomes pinched.

Less Common Cervical Degenerative Disc Disease Symptoms

The more the cervical spine degenerates, the more likely the spinal canal will narrow and put the spinal cord at risk. If the spinal cord becomes compressed, then myelopathy could result and include symptoms such as:

  • Difficulty moving arms and/or legs
  • Trouble with coordination and/or balance
  • Loss of bowel and/or bladder control
  • Weakness and/or numbness anywhere beneath the neck
  • Shock-like pains through the arms or legs, which can be made worse by bending forward

Cervical myelopathy is cause for concern and requires prompt medical attention. It usually occurs in people over age 50.

The condition is typically diagnosed by the following process:

  1. Medical history. First, a doctor will review the patient’s medical history in addition to learning about the current symptoms.

  2. Physical examination. Next, a doctor will perform a physical examination by palpating (feeling) the neck and testing the neck’s range of motion. During the exam, patients may be asked to perform certain movements and report whether the neck pain increases or decreases.

    If the pain is severe or if neurological symptoms are present, such as pain, tingling, or weakness in the shoulder, arm, or hand, then the doctor will likely request an imaging study.

  3. Imaging confirmation. If the doctor determines that an imaging study is needed to check for a potential disc problem, then an MRI will likely be ordered. An MRI, X-ray, or possibly a CT scan can confirm whether and where degeneration is occurring, as well as identify other conditions (such as osteoarthritis or stenosis) that might be causing the symptoms.

Once an accurate diagnosis of cervical degenerative disc disease is confirmed, as well as any other associated conditions, then the source of the symptoms can be understood and an effective treatment program can be created.

When a cervical disc starts losing hydration and stiffening, there are several ways in which neck pain and associated symptoms can develop. Here are the common ones.

Pain from a Degenerating Disc

Most people who have a disc tear do not experience pain from it. The exact reason is unknown, but most experts suspect it has something to do with how the disc’s innervation and pain sensory can vary from person to person. For example, some people might have nerves that naturally go deeper into the disc, while some people might simply have a higher threshold for sensing pain.

  • Discogenic pain. This pain occurs in the disc itself and can range from mild to severe. The disc’s gel-like interior, called the nucleus pulposus, contains proteins that can cause painful inflammation if they come in contact with nerves located in the outer layer of the disc.

    In a healthy adult cervical disc, nerves only go into the outer third of the disc’s protective outer layer, called the annulus fibrosus. However, if the disc’s outer layer gets a tear, then nerves can start to grow deeper into the disc in an attempt to heal itself. The soft inner portion of the disc can leak into the outer rings and come into contact with the small nerves, which can become painful. Some studies have even shown nerves growing all the way into the center of the nucleus pulposus in a painful disc that had gone through significant degeneration.

  • Micro-motion instability. When the disc’s tough outer layer wears down and no longer provides adequate shock absorption and stability, the vertebrae above and below the disc may move more than usual and surrounding muscles can go into painful spasms in an attempt to limit that abnormal movement.

Pain from a degenerating disc can range anywhere from a dull ache to something so intense that it limits movement and activities. In most cases, the pain will subside within a few weeks or months as chemical inflammation of the disc material starts to subside, and/or the disc stabilizes into it new stable position.

Other Conditions Associated with a Degenerating Disc

Cervical degenerative disc disease is often present with other spinal conditions, either developing at the same time or in some cases one causes the other. Some common examples include:

  • Herniated Cervical Disc. A degenerating disc can have its nucleus wedge into tears in the annulus fibrosus. If the nucleus pulposus eventually passes through the annulus fibrosus, then the disc is considered herniated.

    Conversely, a traumatic injury, such as a fall, or other issues could cause a herniated disc that eventually speeds up the disc’s degeneration and leads to cervical degenerative disc disease.

  • Cervical osteoarthritis. As the disc degenerates and the disc space within the vertebral column starts to collapse, the facet joints may abnormally move or sublux and cause wear of the cartilage, as well as develop bone spurs in the neck.

    Cervical spinal stenosis. This condition occurs when there is a narrowing of the spinal canal (where the spinal cord runs through) or foramina (where the spinal nerve runs through), due to bone spurs, as described in the arthritis scenario above.


    As an example, disc degeneration could eventually lead to osteoarthritis, which could eventually lead to spinal stenosis. For some patients, they are born with a congenital form of cervical stenosis and do not need to have disc degeneration to develop symptoms.

Radicular pain may be a symptom of several conditions that occur in the cervical spine, including a herniated disc, degenerative disc disease, spinal stenosis, and osteoarthritis.

Cervical radiculopathy—symptoms of pain, tingling, numbness, and/or weakness radiating down the shoulder into the arm and hand—can result when one or more of the neck’s spinal roots becomes pinched or irritated. For example, a herniated disc or bone spur could pinch a nerve root in the C6-C7 segment that might cause weakness in the triceps and forearms, wrist drop, and altered sensation in the middle fingers or fingertips.

If the spinal cord at the neck level becomes compressed by spinal stenosis, such as from bone spurs or a disc bulge, then myelopathy can develop. Possible symptoms of pain, tingling, numbness, and/or weakness could be felt at that level in the neck and anywhere below. For example, a person could have tingling or weakness in the legs, balance problems, or even difficulty with bowel and bladder control.

It is important to get a medical evaluation if there are symptoms of myelopathy, as the condition may progress and without treatment it is possible to eventually develop paralysis of multiple limbs and body functions.

If pain and symptoms from cervical degenerative disc disease intensify, steps can be taken to help alleviate the problem. The first steps are usually self-care and/or non-surgical treatment options, and typically these will effectively manage the pain.

Cervical degenerative disc disease is diagnosed when a damaged disc in the spine becomes symptomatic.

In rare cases when pain and symptoms persist or worsen despite several months of treatment, or if spinal cord health is at stake, surgery may be considered.

Non-Surgical Treatment Options

For neck pain stemming from cervical degenerative disc disease, a doctor will typically recommend one or a combination of the following treatment options:

  • Rest or lifestyle modification. Certain activities might be more painful for the neck, such as craning the neck forward to look at the computer monitor or a specific swimming stroke. Refraining from or modifying certain activities for a few days or weeks will usually reduce the pain. In addition, maintaining strong posture (instead of slouching while sitting or flexing the neck forward while driving, looking at a cell phone, etc) is recommended. Eating healthy, staying hydrated, and quitting smoking are also all beneficial for disc health.
  • Pain management with medication or injections. Over-the-counter pain relievers, such as acetaminophen (such as Tylenol), ibuprofen (such as Advil, Motrin), or others might be beneficial. If not, a stronger pain medication, such as oral steroids or muscle relaxants may be prescribed. Other options could include an injection that delivers medication directly to a certain part of the neck, such as a cervical epidural steroid injection or a cervical facet injection.
  • Ice and/or heat therapy. Some people find pain relief by applying an ice pack or a heated gel pack to the uncomfortable part of the neck.
  • Exercise and/or physical therapy. Most non-surgical treatment programs for neck pain will include some form of exercise and stretching. A physical therapist or other trained health professional can prescribe an exercise and stretching regimen that meets the specific needs of the patient. In general, increasing strength and flexibility in the neck can lower the risk for pain.
  • Manual manipulation. The cervical spine can be manually adjusted by a chiropractor or other qualified health professional in an effort to improve range of motion and/or reduce pain. Depending on the person’s symptoms, a physical exam and/or imaging study should be done prior to manual manipulation of the neck.

The above list does not include all treatment options for pain related to cervical degenerative disc disease. Many other options could be considered as well, such as massage therapy, electrical stimulation TENS unit, bracing, or acupuncture.

Surgery to treat cervical degenerative disc disease is generally considered in two cases:

  • Neurological symptoms are present, such as persistent arm numbness and/or weakness, or trouble with walking or bowel control. If neurological symptoms are caused by cervical DDD there is a risk of permanent nerve damage, and surgery may be recommended to alleviate pressure on the nerve.
  • Chronic pain is severe and not adequately relieved after at least six months of non-surgical treatments, and daily activities become difficult. Better surgical results are predicted for patients with chronic pain coupled with other findings such as cervical instability, and/or radiculopathy.

The two most common types of surgery for cervical degenerative disc disease are:

  • Anterior cervical discectomy and fusion (ACDF). This procedure is done through the front of the neck and involves removing the problematic disc, decompression of the nerve root, and insertion of a bone graft or a metal cage device to help maintain or reestablish the normal height of the disc space.
  • If there are neurological symptoms from spinal cord compression, the surgery may also include removing part of a vertebra or widening the spinal canal to give more space for the spinal cord before the fusion is done.

  • Cervical artificial disc replacement. This surgery involves removing the problematic disc and replacing it with an artificial disc. The goal of this surgery is to preserve motion at that spinal level. Cervical artificial disc replacement results may be better in patients with minimal arthritic changes to the posterior facets.

For relieving pressure on nerve roots and/or the spinal cord and thus reducing neurological symptoms like arm pain or weakness, neck surgery tends to have a good success rate—some estimates in literature are between 80% and 90%.

However, neck surgery has a lower success rate for relieving pain that is only in the neck itself. If the disc space cannot be verified as the probable pain generator, it may be reasonable to avoid surgery and keep trying various types of non-surgical care to manage the pain.

Lumbar degenerative disc disease

  • Lumbar degenerative disc disease
  • Diagnosis
  • Causes
  • Common Symptoms
  • Treatment Guidelines
  • Surgical Treatments

Lumbar degenerative disc disease

DEGENERATED-DISC-DISEASE

It is a condition that sometimes causes low back pain or radiating pain from damaged discs in the spine. A lumbar spinal disc acts as a shock absorber between vertebrae, and allows the joints in the spine to move easily.

The strong, fibrous outer portion of a spinal disc, known as the annulus fibrosus, contains the soft inner core of the disc, the nucleus pulposus.

 

DEGENERATED-DISC-DISEASE

Each person’s spinal discs undergo degenerative changes as they age, but not all people will experience symptoms as a result of these changes. Symptoms are most commonly seen in 30 to 50-year-olds.

Pain from degenerative disc disease is usually tolerable, with flare-ups that last for a few days or more. It is normally felt in the lower back, but it can radiate into the hips and legs. The pain tends to be worse when sitting, as the discs have to bear a heavier load.

DEGENERATED-DISC-DISEASE

One way degenerative disc disease causes pain is through inflammation of the nerves. When the outer part of a disc breaks down, the inner portion of the disc can leak out, releasing proteins that irritate surrounding nerves. Another cause of pain is when degenerated discs cannot properly absorb stress, leading to abnormal movement along the vertebral segment. Back muscles may spasm painfully in order to stabilize the spine.

 

In some cases, the disc space may collapse enough to compress a nerve root, leading to leg pain known as radiculopathy. Low back pain from degenerative disc disease often goes away with time as inflammatory proteins decrease and the disc collapses into a stable position.

The first steps for a lumbar DDD diagnosis include the following:

  • A medical history is collected that details current symptoms, including when the pain began, if pain is accompanied by other symptoms such as numbness or tingling, and if pain started after an injury. A medical history also gathers information on regular physical activity, sleep habits, and past injuries.
  • A physical exam tests the spine’s range-of-motion and strength. A physical exam may include feeling by hand (called palpation) along the lower spine to locate areas of tenderness, inflammation, or physical abnormalities. Additionally, movement tests that determine which motions or positions alleviate or worsen pain can help indicate where pain is produced in the spine.

The above diagnostic methods are typically enough to diagnose pain from a spinal disc, and most cases can be diagnosed by visiting a primary care physician. Other cases may require insight from a spine specialist and/or additional testing. In order to locate the specific segment of disc degeneration, diagnostic imaging tests may be used.

Diagnostic Imaging for Degenerative Disc Disease

A definitive diagnosis for lumbar DDD may require an MRI scan to ensure that other issues are not contributing to pain, such as a fracture or disc herniation. If surgery is needed, an imaging test is required prior to the procedure to accurately locate the degenerated disc and plan the surgery.

An MRI (magnetic resonance imaging) scan uses a high-powered magnet to align and detect water molecules in the body, which allows doctors to visualize soft tissues such as muscles, ligaments and tendons, and spinal discs. MRI scans rely on magnetism rather than radiation—used in x-ray and CT scans—so there is little risk involved in an MRI scan, and scans are not painful.

MRI scans can provide useful information concerning:

  • Disc height
  • Disc shape
  • Endplate erosion
  • Pinched nerves
  • Disc hydration (if there is little or no hydration, it may be referred to as a black disc, as the disc will appear black on the MRI scan)

Studies have shown that MRI findings of mild or significant disc degeneration are found on scans of patients with severe pain and minimal or no pain. Additionally, many painful conditions may not show up on an MRI, such as a tear in the disc’s outer rings or some cases of herniated discs. For this reason, a diagnosis cannot rely solely on imaging tests and must be used in combination with a medical history and physical examination.

Pain from degenerative disc disease is typically caused by strain on the muscles supporting the spine and inflammation around the disc space.

Degeneration occurs because of age-related wear-and-tear on a spinal disc, and may be accelerated by injury, health and lifestyle factors, and possibly by genetic predisposition to joint pain or musculoskeletal disorders. Degenerative disc disease rarely starts from a major trauma such as a car accident. It is most likely due to a low-energy injury to the disc.

Lumbar Degenerative Disc Disease Causes

The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of following sources:

  1. Inflammation, as the proteins in the disc space irritate the surrounding nerves—both the small nerve within the disc space and potentially the larger nerves that go to the legs (the sciatic nerve).
  2. Abnormal micro-motion instability, when the outer rings of the disc, called the annulus fibrosis, are worn down and cannot absorb stress on the spine effectively, resulting in movement along the vertebral segment.

Over a long period of time the pain from lumbar degenerative disc disease eventually decreases, rather than becoming progressively worse. This pain relief occurs because a fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position, eliminating the micro-motion that generates the pain.

The Degenerative Cascade

When a disc endplate is damaged, the blood supply to the discs is compromised, leading to a lack of nutrients and oxygen that are essential for restoring damaged tissues. Once one stress or injury occurs, a disc can begin to wear down relatively quickly in a process called the degenerative cascade.

The degenerative cascade is a slow process that typically continues for 10 to 30 years and usually consists of the following cycle:

  • An initial stress or injury may occur, causing acute pain that may be severe. Stiffness and limited mobility may occur immediately after the initial injury or stress to the disc. In many cases, there is no clear injury that causes the onset of symptoms.
  • The affected spinal segment then undergoes a long period of relative instability. As the disc height decreases, the muscles, ligaments, and facet joints around the disc space gradually adjust to stabilize the spine again. During this phase, there are periodic flare-ups of moderate or intense low back pain.
  • Once the spinal segment stabilizes, pain and other symptoms tend to alleviate.

It is common that back pain from degenerative disc disease is more severe between ages 30 and 40 than past age 60.

Risk Factors for Degenerative Disc Disease

Lifestyle factors that affect overall health can have an impact on the spinal discs. Risk factors for degenerative disc disease include:

  • Family history of back pain or musculoskeletal disorders
  • Excessive strain on the low back caused by sports, frequent heavy lifting, or labor-intensive jobs
  • Strain on the lumbar spinal discs due to prolonged sitting and/or poor posture
  • Lack of support for the discs due to weak core muscles
  • Obesity
  • Smoking, or any form of nicotine intake

Disc degeneration is a common part of aging, but not all people develop pain or any remarkable symptoms. Symptoms tend to arise when spinal instability, muscle tension, and possibly nerve root irritation occurs.

Most cases of lumbar degenerative disc disease consist of a low-grade, continuous but tolerable back pain that will occasionally intensify for a few days or more.

Symptoms can vary, but general characteristics usually include:

  • Moderate, continuous low back pain. Painful aches at the site of a damaged disc is the most common symptom of a degenerative disc. Pain may spread to the buttocks, groin, and upper thighs. This pain typically feels achy, dull, and can range from mild to severe.
  • Occasional pain flare-ups. Back pain may intensify for several days or weeks then return to a more moderate level. Flare-ups happen as the disc continues to degenerate and the spine gradually stabilizes. Pain flare-ups can be severe and sudden, and can temporarily reduce mobility.
  • Local tenderness. The area of the low back surrounding the degenerated disc may be sensitive to touch. Local soreness is caused by inflammation and muscle tension surrounding the degenerated disc.
    • Pain with sitting. Sitting for prolonged periods often causes more severe low back pain and stiffness until standing up or changing positions. Sitting in a reclined, supported position is usually well tolerated.
    • Exacerbated pain with bending or twisting. Twisting the spine and forward, backward, and side-to-side bending can cause intense, concentrated pain around the disc.
    • Pain relief when walking or changing positions. When the spine changes positions, pressure is removed from the discs and placed on muscles and joints. Frequently changing positions, alternating between standing and sitting, or taking short walks can help alleviate stiffness and keep pain to a minimum.Leg pain. Neurological symptoms including numbness, weakness, or sharp, shooting pains in the buttocks, hips, and/or back of the leg may be felt if the disc space collapses enough to pinch a nerve root exiting the spine. Leg pain from lumbar degenerative disc disease usually does not go below the knee.

       

      Additionally, pain will typically feel better or worse with certain movements, positions, and postures, such as:

      • The proteins in the disc space can cause significant inflammation if they come into contact with surrounding spinal structures, and this inflammation can lead to low back muscles spasms, as well as nerve root pain radiating to the hips and down the back of the legs (also called sciatica).

        Disc degeneration should not cause symptoms of bowel/bladder dysfunction, fever with back pain, unexplained and rapid weight loss, or intense stomach pain. These symptoms are suggestive of more serious conditions and should receive prompt medical attention.

        Related Symptoms

        In addition to low back pain from degenerative disc disease, other symptoms may occur that are caused by or related to the disc degeneration. For example:

      • Lumbar disc degeneration can contribute to the development of lumbar stenosis and/or lumbar osteoarthritis, aLs well as other lower back conditions.

        Symptoms caused by a degenerated lumbar disc can vary widely, depending on how quickly or thoroughly the disc degenerates and how it affects the surrounding spinal structures.

        Giving out symptoms. A feeling of sudden weakness or instability can happen as the disc becomes weaker, creating a sensation that the low back will “give out” with sudden movements.
        A degenerated disc may also lead to a lumbar herniated disc. Neurological symptoms are common when a disc herniates, including sciatica pain in the backs of the thighs that feels hot, sharp, or stinging.
        •  

Treatment for painful degenerative disc disease focuses on minimizing pain, stabilizing the spine, and improving or maintaining mobility.

Degenerative disc disease can usually be treated with a combination of pain management techniques, physical therapy, and other approaches.

Common Lumbar DDD Treatments

Initial pain management methods for degenerative disc pain typically include a combination of the following:

  • Over-the-counter (OTC) pain medications. Aspirin (Bayer), ibuprofen (Advil), or naproxen (Aleve) are common pain medications that can relieve inflammation that contributes to discomfort, stiffness, and nerve root irritation. Acetaminophen (Tylenol) is a pain reliever that interferes with pain signals sent to the brain.
  • Prescription pain medications. Severe pain that is not relieved with OTC medications may be muscle relaxants or narcotic painkillers. These medications are commonly used to treat intense, acute pain that is not expected to last more than a few days or weeks. These medications can be addictive and cause serious side effects, so they must be used with caution and according to instructions provided by the prescribing doctor.
  • Heat and ice. Applying heat to the low back improves circulation, which reduces muscle spasms and tension and improves mobility. Ice packs can reduce inflammation and numb mild pain. It can be helpful to apply heat before physical activities to relax the muscles, and to apply ice after activity to minimize inflammation.

    See Heat and Ice Therapy

  • Manual manipulation. Commonly associated with chiropractic care, manual manipulation is a popular pain management method for low back pain. Practitioners use their hands to apply force and pressure to the back, hips, or other areas, with the goal of reducing tension in the muscles and joints. Manual manipulation has been found to be an effective measure for temporarily decreasing pain, and in some cases is as effective as medication.
  • Massage therapy. Massage therapy can reduce tension and spasms in the low back muscles, reducing pressure on the spine and alleviating pain. Additionally, massage therapy can improve circulation, providing healing nutrients and oxygen to tense muscles.

    See Massage Therapy for Lower Back Pain

  • Epidural steroid injections (ESIs). A steroid injection administered in the space surrounding the spine can reduce pain signals as well as inflammation. A steroid injection may be used in combination with a physical therapy program to provide pain relief during exercise and rehabilitation. When effective, an epidural steroid injection may alleviate pain for a couple weeks up to one year.

     

In many cases a combination of treatments is needed for effective pain management. A process of trial and error is typically necessary to find the treatments that best provide meaningful pain relief.

Prolonged bed rest is not recommended, and typically makes back pain worse. It may be helpful to rest for a day or so when pain is most severe, but staying inactive for prolonged periods can weaken the muscles and stiffen the spine, leading to increased pain.

Physical Therapy and Activity Modification

Physical therapy is often suggested or prescribed to help maintain healthy mobility in the spine. A thorough low back exercise program should include a combination of:

 

Exercise and Physical Therapy

  • Stretching exercises for muscles in the low back, hips, and pelvis, as well as the hamstring muscles. Tightness in these muscles places more pressure on the lumbar spine and contributes to low back pain.
  • Strengthening exercises that build lower back and abdominal muscles to maintain healthy postures and better support the spine. Strengthening exercise programs might include a customized physical therapy program, dynamic lumbar stabilization, tai chi, Pilates, or others.
  • Low-impact aerobic exercise that elevates the heart rate to improve circulation and deliver nutrients and oxygen necessary for healing the body’s tissues. Examples of aerobics that are gentle on the spine include walking, swimming and water aerobics, stationary biking, and running on an elliptical.

Physical therapy programs are usually tailored on a case-by-case basis according to overall health, severity of pain, and personal preferences.

Additionally, making small adjustments to everyday activities (lifestyle modifications) can effectively mitigate pain. For example, wearing a back brace while lifting, or avoiding twisting while lifting, can prevent pain from flaring up due to overuse. Using an ergonomic chair and supportive mattress can also provide daily relief.

Surgical Options

Surgical options are available for people who experience severe pain or significant loss of function and don’t respond to other treatments. The surgery may involve removal and replacement of the whole or a part of the affected disc (partial or total disc replacement). Another option is disc removal (discectomy) with spinal fusion that reduces the movement in the damaged spine segment.