What Causes Discs to Degenerate? | Degenerative Disc Disease

What Causes Discs to Degenerate? | Degenerative Disc Disease

Published by Wichita Chiropractor Dr. Tracy A. Norris, DC, CCEP, Cert. MDT on Aug 16th 2019

Herniated Discs · Bulging Discs · Degenerated Discs · Lower Back Pain · Sciatica · Weakness · Numbness · Leg Pain

Is effective conservative treatment for degenerative disc disease possible?

Many have degenerative disc disease (DDD), in fact it is extremely common, if not a fact of life as we age. However, how do you know that a degenerative disc is causing pain, when so many people with degenerative discs don't have any symptoms? Even current main-stream methods of evaluation such as MRI, CAT Scans and X-rays are powerless in their ability to directly connect DDD with the symptom of lower back pain. Therefore it is in the clinical judgement of the doctor to either perform surgery or not.

The most important task of a doctor or surgeon is offering the right procedure for the right patient leading to a successful outcome. Many patients with DDD, are still capable of non-surgical recovery if given the opportunity to be assessed using McKenzie Diagnosis and Therapy® (MDT) methods by a qualified practitioner.

The purpose of the center of the disc (nucleus pulposis), is to balance and appropriately distribute the load of the body across the disc. When this nucleus is displaced away from its normal centralized position for extended times, the function of the disc, the inability to properly distribute the body’s mass appropriately leads to increased pressures that cause degeneration over a period of time. (Kramer 1990, p.29). The disc becomes vulnerable when the outer portion of the disc (annulus fibrosis) starts losing its elasticity and allows the inner nucleus material to be displaced beyond its normal limits. The nucleus actually “bleeds” into cracks and tears into, and exerts pressure on, the annulus, causing pain and other symptoms.

Given that displacing the nucleus away from its central location causes disc degeneration, it is then quite logical that by applying a force produced by a certain body position or posture to return the disc to a more central location, thereby helping to restore the inherent functionality of the nucleus, would be therapeutic and allow some resistance to further degenerative processes.

How To Determine Whether Disc Surgery Is Necessary Or Conservative Treatment Will Be Effective

Determination of whether conservative treatment may be helpful for a damaged or degenerated disc is completely dependent on whether or not the outer annulus has enough integrity to maintain the internal disc pressure, called “hydrostatic pressure”. The pressure inside the disc is necessary for the disc to perform its inherent “weight distribution” function, but also in the ability to be able to affect changes to a damaged disc during treatment.

How Hydro-static Pressure Works Inside Disc

Spinal Disc Degeneration - Hydrostatic Model

Have you ever tried to pop a balloon by sitting on it? If so, you already have an understanding of how pressure inside the disc works. When you try to sit on the balloon, the weight of your body causes the air inside to be displaced in the direction of lesser force. Sitting on the top of the balloon and trying to balance on it, is essentially how the disc normally operates, conforming and displacing the weight that is placed upon it. If you continued to sit on the balloon with the air forced to one side for a period of time, then stood up, that balloon would rebound to it’s normal shape if the balloon has not popped or lost its internal pressure.

In comparing the balloon to the disc, as long as the disc has its internal pressure you can apply forces to affect it, which either improves or worsens symptoms. If you push the disc further into deformity, symptoms worsen. If you push the disc in the opposite direction of its deformity, symptoms should improve. But the internal pressure is required in order to be able to affect the disc in this manner. If the disc is blown, and has no internal pressure, just like a popped balloon, you can’t affect the disc tissue with any type of positive force.

The difference between needing surgery and possibly avoiding surgery can be determined by testing the internal pressure of the disc by applying different loads (directional movements) to the disc and observing the result on the symptoms. If a movement is found to affect the pain (either worse or better), it indicates that the internal pressure is somewhat intact and there is a possibility that conservative measures will be effective. However, if no movement can be found to improve or worsen the pain, then the likelihood that the disc internal pressure mechanism has been damaged, and surgery may be indicated.

“In my nearly twenty years of surgical practice, MDT (McKenzie Diagnosis & Therapy) assessment consistently yields not only clinical success, i.e. good non-surgical outcomes…(which) enhances the precision of my surgical selection process and thereby improves surgical outcomes”

--F. Todd Wetzel, MD, Professor of Orthopedic Surgery and Neurosurgery Temple University School of Medicine, Rapidly Reversible Back Pain by Ronald Donelson, Intro p.xiv).

MDT is an Explanatory Model With Educational Validity That Points To Care That Works. An Evidence-Based Approach To Objectively Determining a Means Of Helping Patients With DDD Without Drugs, Imaging , Specialist Referrals and Back Surgery. 

--Donald Kollisch, MD, Department of Community and Family Medicine, Darmouth-Hitchcock Medical Center, Rapidly Reversible Back Pain by Ronald Donelson, Intro p.xv)

Not all degenerative disc disease causes pain, and not all degenerative disc disease can be helped.  You need to be tested by a qualified professional in McKenzie Diagnosis and Therapy. 

References

  • 1.(35.Croft P, et al., Outcome of low back pain in general practice: a prospective study. British Medical Journal, 1998. 316: p. 1356-9, 110. Pedersen P, Prognostic indicators In low back pain. Journal of Royal College of General Practice, 1981. 31: p. 209-16, 130. Smedley J, et al., Natural history of low back pain: a longitudinal study in nurses. Spine, 1998.23:p. 2422-6.)

2. Waxman R, Tennant A, and Heliell P, A prospective follow-up study of low back pain in the community. Spine, 2000. 25(16): p. 2085-90.

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