Video and Transcript: What is Degenerative Disc Disease

Hi guys! Doctor Orit Hickman here (physical therapist from Pain Science Physical Therapy.) I just wanted to put together a really quick video to address a question that we get a lot in the clinic.

We treat a lot of patients with spine pain. So, by spine pain we mean low back pain, mid back pain, neck pain, and even sciatic symptoms. We can -- we’ll call it sometimes spine pain just because of where it may be coming from. And typically, by the time we see a patient they will have already -- maybe they’ve seen multiple physicians, multiple PTs, multiple other practitioners who specialize in the treatment of the spine. And oftentimes they will have definitely had at least one, if not two or three or 20, X-rays and MRIs. 

The facts are that the number of patients getting imaging studies in this country has been skyrocketing in the last 10 to 15 years and the number of patients with spinal pain is also growing in that time. We're seeing more patients having injections every year. 

We’re not seeing lower rates of pain, which is why we as a clinic commit to educating patients on spine pain, as well as pain in general because not all pain is created by something happening in the tissues. In fact, no pain exists in the body unless your brain makes a decision that you need to feel something. That is a separate video. 

The question I want to address today is: what is degenerative disc disease?

Besides being a really scary diagnosis that doesn't really tell anybody anything, DDD (degenerative disc disease) for most patients that we treat in our clinical setting the diagnosis is really age-related changes. 

So, what do we know about this one? We know that if we start taking images (and by images I mean X-rays or MRIs) of somebody's spine starting in their mid-twenties, what will see are age-related changes. We’ll see discs that have gotten smaller. We’ll even see beginning signs of arthritis. And we’ll see lots of things that will kind of be like, “Alright we see that, but they’re not -- the patients not having any pain.” 

Every decade that you live in your body, you are going to have more and more age-related changes that are occurring to your tissues. These are just facts we see on the outside. We see wrinkles. We see age-spots. We see our bodies’ shape changing. So, why would we expect it to be any different on the inside? The reality is that those changes do not need to cause pain, and the more that you understand about a diagnosis, the less afraid you're going to be about it. 

So, let’s talk about the spine very quickly. 

These are just square blocks, but they're supposed to represent your vertebrae, which are your spine bones. In between each of the vertebrae, you have a disc. A disc is a thick piece of cartilage, and its job is to be a shock absorber, respond to movement in the spine. And the discs are anchored on the top and the bottom to the vertebrae above and below, which means that the discs do a wonderful job of preventing movement between the vertebrae. 

Your discs -- if we look at your discs from the side, your disc is kind of kidney bean shaped and the center has a small area of fluid. That fluid is not squishy or very easily liquidy like water. It's thicker more viscous, and that fluid will move and respond to changes. So, if I bend forward, that fluid shifts a little bit back or gets pushed back a little bit. And if I bend backwards, that fluid moves a little bit forward. It's normal. 

What can happen in -- what we call -- in this very scary diagnosis of degenerative disc disease, which really again means only age related changes, over time we lose fluid in our body. We lose water. This is normal. This is natural. All of our joints lose water with time, with age. 

Well, what can happen is the disc can get smaller. The disc can get a little thinner, can get a little flatter over time. You can also see that the bones on either side of the disc might start to form changes that come down. So, the bones could actually touch each other and the disc gets a little bit more rounded, curved in its edges, rather than just straight across. This is a very, very, very common thing that we see. We can see it throughout the entire spine. And, like I mentioned, this can start pretty young. This can start in our twenties. 

So, what do we know about this? It is normal. It's common and there are a lot of people walking around with these age-related changes who have absolutely no pain. So, try not to be afraid of the diagnosis, and I hope this helps. 

If you have any questions, thoughts, concerns, please feel free to comment below and give this video a thumbs up if you liked it. Pass it on to friends and family because the more that we understand about these diagnoses the less afraid we’ll be, and the less pain we’ll be experiencing. Have a great day!