Degenerative disc disease (osteoarthritis)
Disc Degeneration is a common cause of pain, most frequently felt as a stiff neck or achy back. The human spine is made of up 24 bones called vertebrae separated by rings of tough elastic cartilage. These rings act as shock absorbers to cushion the movement of each vertebrae. Over time these discs become flattened most commonly due to abnormal aging process, poor posture, and/or injury to the spine.
The symptoms of Disc Degeneration can range from slight stiffness to severe pain, loss of range of motion, and may also include referred pain, numbness, tingling, and/or weakness of the neck, mid back, low back, and extremities which is a result of the nerves that are in between each vertebra becoming irritated or pinched by productive bony change.
Cervical disc degeneration. Notice the anterior shift of the cervical spine in the diagram and in the x-ray. Disc spacing is minimal at best and the anterior shift transfers all of the weight onto the posterior joints of the spine, the facet joints. Once this happens the body responds to added weight or stress by laying down new bone that can meet that stress. This is what osteoarthritis is. Besides the stiff achy neck that you will feel with this, you may also experience sharp or dull electric like sensations into the arms as you move your neck wrong. This is due to the productive changes to the facet joint that is now encroaching on the hole where your nerves exit. These pains down the arm, if realized which finger or area of the arm, can tell you what level is involved (look at dermatomal chart on left).
Common Symptoms of Cervical Disc Degeneration:
· Stiff achy neck, pain with flexion and rotation of head.
· Dull Ache in shoulder, elbow, upper and lower arm.
· Numbness, tingling or burning in hand, and / or fingers.
· Crunchy sound when you move your neck. This happens because sounds made by bone will travel faster than sounds in air.
Lumbar disc degeneration. Look at the lumbar spine (left diagram) and notice how the discs at the last 2 vertebrae are nearly missing. This is due to the degenerative process that causes them to break down as well as loose hydration. The spurring seen is due to the bodies attempt to stabilize. Think of a car tire as a disc, and now take some air out of it. What happens when you turn? It squeals and slides, right? This is what happens when you take the discs hydration from it, it slides and glides. The body noticing this now puts down new bone to attempt and wedge it into a stable position and continues to do so if proper joint mobility isn’t restored. This is particularly problematic if the degeneration extends into the back part of the vertebrae blocking off the hole where spinal nerves exit. If this happens you will notice numbness, tingling, or pain in the legs that seems to get worse with prolonged standing and better with sitting down or bending over something. When you bend forward or sit down this will increase the diameter of the hole where the nerve can exit allowing leg symptom relief. This is why the recommendation of exercise with this condition, is to be in a seated position riding a pedal bike rather that running in an upright position. The distribution of leg symptoms will also tell you what area is becoming impinged look at the dermatomal map below.
Common Symptoms of Lumbar Disc Degeneration:
- Stiff lower back with flexion and rotation of hips.
- Dull ache in hip and buttocks that travels down leg.
- Numbness, tingling or burning in legs, foot, and/or toes.
- Pain may be worse with movement, or standing for long periods of time.
- Patient may experience spasm of back muscles.
Benefits of Spinal Manipulation:
While chiropractic manipulation cannot reverse the abnormal aging process, it allows the body to normalize proper joint motion by restoring joint mobility, increasing range of motion, and helps with the exchange of nutrients for maintaining the integrity of discs, joints, ligaments and cartilage. Spinal manipulation also helps by gaping facet joints that have become to close causing reduction of the diameter of the hole where nerves exit. It is important to be evaluated for this condition to make sure that it is not another condition that mimics these symptoms, like a bulging disc. Evaluation can be effective with the use of spinal x-rays that will show these productive bony changes, as well as evaluate disc spacing. Discs themselves are not visible on x-ray and if suspicion of a bulge is present, the need for MRI to investigate further may be warranted.
Written by: Christopher G. Stine, M.S., D.C.
Images from: Frank Netter Atlas of Human Anatomy 6th edition.