Degenerative disc disease

Degenerative disc disease or known as spondylosis can be referred to as osteoarthritis (OA) of the spine. In the past OA was considered to be a “degenerative joint disease” which implied a passive process with old age. This is misleading because OA is a multifactorial and active disease that usually begins in the middle age population, although individuals suffering from OA symptoms are usually above the age of 40 years. OA can be classified broadly into primary and secondary. Primary OA presents with no obvious cause for the joint disease. Secondary OA results from abnormal wear and tear of a joint following a clearly defined insult. OA / spondylosis is characterised by localised loss of articular cartilage / intervertebral disc; remodeling of the underlying or adjacent bone / vertebra by way of overgrowth known as osteophytosis or “spur” formation; and associated inflammation and pain. 

Spinal nerves exit the spine to supply the skin, muscles and joints of the respective limb they innervate for the purpose of providing sensation, strength, movement, coordination and proprioception. A nerve entrapment or a “pinched nerve” of the spine occurs when a spinal nerve becomes irritated and / compressed and presents with pressure symptoms; a set of conditions in which one or more of their nerve roots are affected and do not work properly known as radiculopathy. Although there are numerous causes for nerve root entrapment, of the most common causes for radiculopathy in fit young adults is a herniated disc and in the older population degenerative disc disease.

An intervertebral disc is a layer of strong, cushion-like pad tissue that lies between adjacent bone segments that make up the spine known as vertebrae. Each disc forms a joint, namely a fibrocartilage joint, to allow some movement of the vertebrae; acts as a ligament to hold the vertebrae together; and importantly serves as shock absorbers of the spine. A herniated disc or known as a "slipped disc" is a painful condition where the inner portion of the disc known as the gelatinous nucleus pulposes squeezes through a tear in the outer layer of the disc known as the annulus fibroses. The prolapsed disc material can cause pressure symptoms of the nerve roots below the level of the herniation, most commonly of the lower lumbar spine (low back) and the lower cervical spine (neck). A herniated disc is most commonly seen in fit young adults with a history of heavy, awkward straining or lifting, or in older people with degenerative changes of their spine.

Degenerative disc diseases of the spine can cause radiculopathy by compressive and non-compressive neuropathy. Neuropathy refers to a problem with the nerves, predominantly of the spinal nerve roots. Degenerative disc disease can cause compressive neuropathy and subsequently radiculopathy by way of a herniated disc and / spur formation that encroaches on the spinal nerve root(s). A herniated disk is less likely to occur in the elderly due to the thickness of the degenerated intervertebral disc that has been lessened by the desiccation of the nucleus pulposes. Degenerative changes of an intervertebral disk can cause non-compressive neuropathy and contribute to radiculopathy by causing the release of inflammatory cytokines that irritate the spinal nerve roots. This is a biochemical rather than a biomechanical disorder. Inflammatory cytokines are type of signalling molecules that are excreted to promote inflammation in the response to an insult and subsequently result in / contribute to pain. It is important to note, that there is often a mixed picture of compressive and non-compressive neuropathy in a degenerative spine.

The most common symptoms of degenerative disc disease include neck / back pain; neck / back stiffness and muscle spasms with limited movement; and possible symptoms of nerve root entrapment. Nerve root entrapment symptoms include pain felt along the buttock, back of the thigh and leg known as sciatica; pain felt going down into the arm and / forearm known as brachalgia; pins and needles” and numbness in the leg and / foot, or in the forearm, hand and / or fingers. In more severe nerve root compression there may be strength loss of the affected muscles of the arms / legs in the distribution of the affected nerves known as motor loss. Pain in itself presents as a complex biopsychosocial issue in relation to a human being’s expectation of self-efficacy, that is, the human being’s belief in their ability to complete tasks and reach goals are adversely affected and are associated with detrimental changes in mood, sleep, coping abilities and lower financial income.

Degenerative disc disease treatment

At Vincere Health Chiropractic we utilize combinations of advantageous therapeutics when indicated to provide you with pain relief where other single therapeutics fail, including spinal manipulation; Extracorporeal Shockwave therapy; myofascial release / massage techniques; therapeutic taping techniques and of importance core rehabilitation and rehabilitation of weak postural muscles of the cervical spine (neck). Extracorporeal Shockwave therapy (ESWT) has been shown to produce positive therapeutic effects in osteoarthritis:

The conventional conservative treatment for degenerative disc disease is very limiting before surgical intervention. The conservative management, excluding chiropractic treatment, entails mobilization and rehabilitation of the affected joints, to a certain limit of which the affected joints can tolerate without inducing more degenerative changes (“wear-and-tear”). A 3 to 6 treatment session with ESWT with an interval of 3 to 6 days between the interventions were administrated to subjects with confirmed osteoarthritis of the knee joint. Visual analogue scale pain scores (represents the painful syndrome associated with osteoarthritis); morning stiffness rate (morning stiffness is a clinical manifestation associated with arthritis); and joint index and functional index scores (indicate functioning of the joint) were measured at baseline and post-interventions. The baseline scores served as the control. The post-treatment sessions with ESWT showed that the visual analogue pain scores reduced significantly in 85 % of the subjects (p < 0.05); the mean morning stiffness rate was reduced by 44 %; the joint index improved by 39 %; and the functional index improved by 18 %. The control did not show such favorable effects. ESWT can be used as an effective conservative treatment option for osteoarthritis, may reduce the painful syndrome associated with osteoarthritis in 85 % of cases, and may improve the functioning of the affected degenerative joint (Sheveleva and Minbaeva 2014).

In addition, a significant correlation has been established between chronic low back pain and weak core musculature. The back and abdominal muscles, especially the multifidus and transverse abdominus, can be referred to as “core muscles”. These muscles play an important role in providing strength and stability to the lumbar spine especially in the presence of degenerative changes in the spine. Core muscles can become weakened due to straining or under use. Also, these muscles tend to become weaken with age unless specifically exercised. Weak core muscles may also contribute to degenerative disc disease of the lumbar spine.

Similarly, a significant correlation has been established between chronic neck pain and weak postural musculature of the cervical spine, especially the upper thoracic extensor and deep cervical flexor muscles. These muscles play an important role in providing strength and stability to the cervical spine and to keep the head back onto alignment over the shoulders especially in the presence of degenerative changes in the spine. Postural muscles of the neck can become weakened due to straining or under use. Also, these muscles tend to become weaken with age unless specifically exercised. Weak postural muscles of the neck may also contribute to degenerative disc disease of the cervical spine.

 

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