Degenerative Disc Disease: Physiotherapy Management

Degenerative Disc Disease: Physiotherapy Treatment

Degenerative disc disease (DDD) is a condition that affects the discs between the vertebrae of the spine resulting in degeneration of intervertebral disc. These discs act as cushions or shock absorbers for the spine, allowing it to bear weight in certain positions like flexion, bending, and rotation. With degenerative disc disease, these discs gradually lose their ability to function effectively due to wear and tear, leading to various symptoms and complications.

 

Types of Degenerative Disk Disease

Degenerative disc disease (DDD) is primarily categorized based on the region of the spine it affects and the severity of the degeneration.

Types of Degenerative Disc Disease based on location:

• Cervical Degenerative Disc Disease
• Thoracic Degenerative Disc Disease
• Lumbar Degenerative Disc Disease

Classification based on the severity of the degeneration:

• Early Stage Degeneration: 

In this stage, the intervertebral discs may exhibit signs of dehydration and loss of disc height, but symptoms might not be present or may be mild.

• Moderate Stage Degeneration: 

As degeneration progresses, there may be more significant loss of disc height, formation of osteophytes (bone spurs), and narrowing of the disc space. Symptoms such as pain and stiffness may become more noticeable.

• Advanced Stage Degeneration: 

In this stage, there is severe degeneration of the discs, leading to significant loss of disc height, collapse of disc space, and potentially more severe symptoms such as chronic pain, nerve compression, and functional limitations. Structural changes in the spine, such as spinal curvature abnormalities (e.g., kyphosis or scoliosis) is also seen.

Stages of Degenerative Disc Disease

Symptoms

• chronic or intermittent pain
• stiffness
• decreased range of motion
• Numbness and tingling
• muscle weakness in the arms or legs
• pain worsened by certain activities - such as bending, lifting, rotation, or prolonged sitting or standing
• temporary relief from pain when resting or lying down
• difficulty with daily activities 

Causes

• age
• genetics predisposition 
• repetitive stress and mechanical factors - heavy lifting or prolonged sitting
• poor posture and improper body mechanics
• obesity
• smoking
• acute injuries to the spine such as herniated discs or vertebral fractures
• poor nutrition - such as vitamins C and D, calcium, and magnesium
• rheumatoid arthritis
• ankylosing spondylitis
• sedentary lifestyle

 

Differential Diagnosis

• Herniated Disc (Disc Herniation)
• Spinal Stenosis
• Spondylolisthesis
• Facet Joint Osteoarthritis
• Muscle Strain or Sprain
• Compression Fracture
• Ankylosing Spondylitis
• Rheumatoid Arthritis
• Fibromyalgia

Diagnosing Degenerative Disc Disease

In physiotherapy, diagnosing degenerative disc disease (DDD) typically involves a comprehensive assessment of the patient's symptoms, medical history, physical examination findings, and functional limitations. Here's how DDD can be assessed and diagnosed in physiotherapy:

Patient History:

The physiotherapist takes a detailed medical history, including the onset and duration of symptoms, the location and nature of pain i.e. is it chronic low back pain and does pain occur in gluteal region, aggravating and alleviating factors, any previous injuries or surgeries, and the patient's activity level and functional limitations. The patient is also checked for tenderness over the involved area

Physical Examination:

A thorough physical examination can be conducted to assess posture, range of motion, muscle strength, and neurological function. Specific tests may be performed to identify signs of nerve compression or irritation, such as sensory changes, muscle weakness, or reflex abnormalities.

Functional Assessment:

The physiotherapist should evaluate the patient's ability to perform functional activities related to daily living, work, and recreational pursuits. This may include assessing gait, balance, lifting mechanics, and other functional movements that may be affected by DDD.

Special Tests:

Certain tests are performed to provoke or reproduce symptoms associated with DDD, such as the straight leg raise test or foraminal compression test.

Imaging Studies:

Imaging reports include the following:

• X-rays - shows presence of bone spur and reduction in disc space
• CT scans - can identify nerve compression
• MRI - depicts disc hydration and morphology

 

Physiotherapy Treatment for Degenerative Disc Disease

Pain Management:

Various methods may be used for pain management which includes:

• Application of heat
• Cryotherapy
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Therapeutic Ultrasound
• Laser Therapy
• Acupuncture

Manual Therapy:

Manual therapy techniques are performed such as

• Joint Mobilization
• Soft Tissue Mobilization
• Manual Traction - can help improve spinal mobility, reduce pain, and alleviate muscle tension

Core Stabilization Exercises:

Targeting the deep stabilizing muscles of the core, such as the transversus abdominis and multifidus muscles, can help support the spine and reduce strain on the intervertebral discs.

3-D spinal stabilization exercise - Quadruped Opposite Arm and Leg Raise

Stretching Exercises:

Stretching exercises are performed for the muscles surrounding the spine and can help improve flexibility and alleviate muscle tightness, enhancing overall spinal mobility. Some examples include:

• Mckenzie Exercise - for acute condition
• Cat Cow Stretch
• Child Pose
• Hamstring Stretch

Strengthening Exercises:

Targeted strengthening exercises for the muscles of the back, abdomen, and hips can help improve spinal support and stability, reducing the risk of further injury. Some examples include:

• Hip flexor and extensor strengthening
• Abdominal muscles – Williams Method
• Pelvic Tilt
• Bridging Exercise

Aerobic Exercise: 

Low-impact aerobic activities such as walking, swimming, or stationary cycling can help improve cardiovascular fitness and overall health without placing excessive strain on the spine.

Emphasizing the importance of long-term spinal health and encouraging ongoing exercise, proper posture, and lifestyle modifications to prevent further degeneration and maintain optimal spinal function. Periodic reassessment and follow-up to monitor progress, adjust treatment strategies, and address any emerging issues or concerns.

Frequently Asked Questions

How common is intervertebral disk degeneration?

Intervertebral disc degeneration is relatively common, especially as people age. It's a natural part of the aging process and can occur in varying degrees of severity. While exact prevalence rates can vary depending on the population studied and the diagnostic criteria used, research suggests that the majority of people over a certain age, typically around 40 or 50 years old, will show some signs of intervertebral disc degeneration on imaging studies such as MRI.

What are degenerative disc disease self-care methods?

• performing low-impact activities such as walking or stationary cycle etc.
• performing core-strengthening exercises
• maintaining good posture while sitting, standing, and lifting 
• avoid prolonged periods of sitting or standing in one position
• take breaks to stretch and change positions regularly
• maintain a healthy weight 
• apply heat packs to relax muscles and increase blood flow.
• using cold packs or ice wrapped in a towel for 10-15 minutes to reduce inflammation and numb pain.
• practice relaxation techniques such as deep breathing
• use lumbar cushions or pillows 
• use supportive mattress and pillows that promote proper spinal alignment during sleep

 

What does degenerative disk pain feel like?

Degenerative disc pain can manifest in various ways depending on the severity of the condition and individual factors. It can be dull or occur in form of intermittent episodes. Similarly it can be localized or radiate towards extremities.

 

What is the best pain relief method for degenerative disc disease?

• The best pain relief exercise method for degenerative disc disease includes low-Impact aerobic exercise and core-strengthening exercises which can also be done with physio ball.

What are degenerative disc disease medication?

• Medications can play a role in managing pain and inflammation associated with degenerative disc disease. Here are some commonly used medications:
• Acetaminophen (Tylenol) - excessive use can lead to liver damage
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Examples include ibuprofen (Advil, Motrin) and naproxen (Aleve) - long-term use may increase the risk of gastrointestinal bleeding and kidney problems.
• Muscle Relaxants such as cyclobenzaprine (Flexeril) or baclofen (Lioresal) 
• Short-term courses of oral corticosteroids, such as prednisone but long-term use of oral steroids can lead to serious side effect.
• Creams, gels, or patches containing NSAIDs (e.g., diclofenac gel, lidocaine patches) 

 

Do I need surgery for degenerative disk disease?

Surgery may be considered if conservative treatments fail to provide adequate relief and symptoms significantly impact your quality of life.