Problems with the intervertebral discs of the spinal column can be in many forms. These can range from thinning or deterioration to herniating or rupturing. As the discussion of the various forms of disc problems is somewhat lengthy I am going to cover them in separate columns. This column will focus on disc deterioration or “degenerative disc disease”. One thing I want to put to rest right away is the term “slipped disc”. This is a very commonly used inaccurate term to describe disc problems. There is no such thing as a slipped disc. The discs are firmly attached to the vertebrae and are surrounded by ligaments and muscle. There really is no room for discs to slip or move so the term slipped disc is not an accurate one. Now, before going into what disc deterioration/degeneration is lets talk about what a normal healthy disc looks like and its function.
Spinal discs are supple cartilage pads that are tightly fixed between the vertebrae. Each disc is a flat, circular capsule about one-quarter inch thick and contain about 80% water when we are young. They have a tough, fibrous, outer membrane called the annulus fibrosus and an elastic gel-like core called the nucleus pulposus. A disc serves as a spacer or cushion between the vertebrae and allows for movement to occur between them. It also helps to absorb shock as our bodies move.
One of the most common disc problems that is going to essentially affect all of us at some point in our lives is degeneration also known as “degenerative disc disease” or “DDD”. This is an unfortunate term as it contains the word “disease” which makes a somewhat normal process sound scary. I can’t tell you the number of times a patient has related to me that their doctor told them they had DDD but didn’t bother to explain to them that is a common and somewhat normal process that accompanies aging. (This is also why we get shorter as we get older as the discs make up for one quarter of the height of the spine) Unfortunately, DDD can lead to “DJD” or “degenerative joint disease” otherwise known as arthritis. These arthritic changes are your body’s way of stabilizing the spinal segment. As the disc deteriorates or thins the vertebrae come closer together making the segment somewhat loose or unstable. This could lead to the vertebrae shifting and possibly hitting on the spinal cord. Thus arthritis is a necessary evil. Even though arthritis, as many of you are aware, can be painful; most of us have arthritic changes in our spines and aren’t even aware that it’s there. One reason for this is that the process of degeneration of the disc is very slow and occurs over years of time with the subsequent formation of arthritic changes also being a very slow process. This allows us to gradually get used to these changes over time with the effect being that we don’t even realize we have any discomfort or stiffness. Many times people are shocked when I review their x-rays with them and they see the disc degeneration and arthritic changes that are there and relate that they never felt it. Should you experience a trauma such as a fall or an auto accident however these underlying changes can be brought to the surface. This can account for why a rather mild fall or accident can result in a lot more pain than you would have thought.
Another problem that can result from DDD and subsequent DJD is that the resultant arthritic changes can take the form of boney spurs. These spurs can grow into the openings on each side of the vertebrae where the nerves exit off the spinal cord or into the spinal canal itself where the cord traverses through the spine. This causes narrowing or stenosis of these openings and thus compressing on and irritating these structures. This can give pain into the arms or legs.
As stated earlier, when we are young our discs contain about 80% water. As we age this water content decreases thus allowing the thinning and degeneration to begin. Trauma to the discs in the form of falls or accidents can also damage the disc beginning the process. Discs have no real direct blood supply. They get their nutrients and get rid of their waste products through a process called imbibation. It works a bit like a sponge. When the joint space opens up on movement the pressure is taken off the disc and it absorbs fluid and nutrients, when the space is compressed it pushes out waste products. (When you wake up in the morning you are taller than you were when you went to bed; this is due to the pressure being off the discs while your lying down thus allowing them to absorb fluid and become thicker) When the disc is damaged from a trauma it has a harder time repairing than other blood rich tissues and thus the deterioration process is easily started.
What can be done for DDD/DJD? As a chiropractor I physically work with these joints. One of the problems that results from DDD/DJD is a loss of normal movement in these spinal segments. This loss of motion is irritating to the interlocking joints of the spine. One of the biggest things a chiropractor does is to restore mobility to these stuck or fixated joints through manipulation. Spinal manipulation is a safe and proven method of treating this problem and relieving its painful effects. Manipulation helps to restore movement allowing for increased imbibation and making the remaining disc material healthier and more functional. As I tell my patient’s-“ I’m going to take your lemons and try to make some lemonade.” Can I make the deteriorated discs brand new again, no. Can I make the spinal segments affected by the degeneration function better and feel better, yes. Along these same lines exercise and movement are good for your spine and helps to keep it mobile. One of the better exercises to do is yoga as it puts all of the joints of your body through their full range of motion. Another great exercise, and simple to do, is walking. Grab your spouse or a friend and get in the habit of doing a daily walking routine.
Another possible help for disc degeneration are the nutritional supplements glucosamine sulfate and MSM (methyl sulfonyl methane). If you look these two up you will find studies that support them and vice versa. I opt on the side of recommending them to my patients but I tell them to look them up online and to make the ultimate decision for themselves.
One last bit of advice on trying to preserve your disc health is to stop smoking. Smoking and its effects are damaging to the discs. Much along the same process that a smoker develops facial wrinkles their discs are also affected.
In my next column I will discuss “disc bulging”. Stay tuned!
Dr. David D. Godwin
Salisbury Chiropractic
Salisbury, NC
www.salisburychiropractic.us