Degenerative Disc Disease Isn't What You Think It Is
Not all "degeneration" is created equal. Don't let this silly diagnosis get you down.
Setting the Scene
Let's set the scene on a common experience many people with back pain go through.
You develop some lower back pain. It may have developed gradually or resulted from an injury, such as lifting something heavy or while bending over.
It begins to really affect your day-to-day life. You struggle to control the pain and it's getting in the way of your ability to perform all the normal daily tasks of work and life.
You go to the Doctor seeking answers to your pain. They send you to get an MRI of your spine.
The results come in. You have "Degenerative Disc Disease".
Your concern grows...
What does this mean? Are you broken? Is it all downhill from here? Is the pain just going to get worse?
Maybe you are only young. Perhaps even in your 20's. How could you already have a degenerative disease? How are you going to avoid a life of pain and disability?
One of These Things is Not Like the Other
I hear this story play on repeat all the time. And it really is an indictment of the way our current health care system treats back pain.
When we hear the term "degenerative disc disease" (otherwise referred to as DDD), the very normal response many people have is to associate it with other degenerative conditions, such as Parkinson's disease or Multiple Sclerosis. These are conditions that will lead to progressive degeneration, loss of function and increased disability.
They are horrible conditions to be diagnosed with. Due to our capacity for 'Hedonic Adaptation', degenerative conditions often lead to a lower perceived quality of life compared to many significant acute traumatic injuries.
Hedonic adaptation refers to the observed tendency of humans to quickly return to a relatively stable level of happiness despite major positive or negative events or life changes.
Humans are wired to always want to move onwards and upwards. We have an innate desire to make progress (perhaps sometimes to our own detriment). So it isn't hard to see why someone being told they are going to 'degenerate' can have a really negative effect on their lives.
The problem though, is that "degenerative disc disease" is no more a disease than 'ageing' is. It is not in the same class as other degenerative diseases. But our health system often leads (or at the very least allows) people to believe that it is.
DDD is a Useless Diagnosis
So what IS degenerative disc disease (DDD)?
Well that question is exactly the problem. DDD is a completely non-specific diagnosis.
To illustrate this, here is a snippet from radiopedia.org:
Wide variations exist in the reported prevalence of degenerative changes in the spine, likely related to differences in populations studied and variable definitions of what constitutes degenerative change. Additionally, because degenerative disc disease encompasses such a wide variety of individually defined entities, it is hard to make broad statements about its incidence and related symptomatology.
Vertebral osteophytes, disc height loss, disc signal intensity loss, and disc bulging increase in frequency with age in a nearly linear fashion, but to different degrees, with disc signal loss and vertebral osteophytes increasing the most with age.
That's quite a mouthful to try and digest. But the main takeaway I'm sure you can get a sense of is that DDD does not really have a specific definition, and all the possible changes that can be related to a DDD diagnosis are common changes that occur with ageing.
And the really key point to note here is that all of these age related changes do not necessarily cause pain.
That doesn't mean they can't cause pain. In some people, one or multiple of these changes can absolutely be involved in a pain mechanism they are experiencing.
But this does illustrate how degenerative disc disease is no more a disease than ageing is a disease. And a diagnosis of DDD is mostly meaningless and unhelpful.
Many adults will eventually develop changes that would constitute a DDD diagnosis, but most of them will not have pain.
What you need is a diagnosis of the specific pain mechanism that's occurring in your spine and what structures are related to that pain mechanism. Then can you take actionable steps to get out of pain.
(Check out the Differential Diagnosis series I’m working on to get some help identifying your pain mechanism.)
Because you really shouldn't care what your spine looks like on an MRI. Most people spines will look pretty horrible by the time it's all said and done.
What you really care about is whether you are in pain, and whether you can enjoy your life without pain. Degenerative disc disease is completely hopeless in predicting whether you will have pain or informing you on what to do about it.
Healing Vs Degeneration
A MRI finding that often leads to a DDD diagnosis is a loss of disc height. As we have well established though, this is NOT a disease. But rather a natural response to injury.
It's very common following disc injuries (particularly those that have been poorly managed) to eventually lead to a loss of disc height. This loss of height may or may not cause symptoms. When it does, it often relates to a loss of stability at that level of your spine which can cause painful micromovements.
A flattened disc is a bit like trying to drive a car with a flat tyre.
A flattened disc can also cause the facet joints that link between our vertebrae to rub together more than they should. This can create some extra friction leading to inflammatory changes at and around these joints. This again, may or may not be associated with pain.
Now what I have just described in many ways IS degeneration. However... it is not a disease. It's our bodies natural healing response. And may actually be our body doing exactly what it is supposed to.
You see, these inflammatory changes will eventually lead to stiffness and reduced mobility in the spine. That might sound like a bad thing, but what problem will that be solving?
The instability caused by the flattened disc. We tend to always think of arthritis as a bad thing (and often it is). But we are missing some nuance by only seeing it as a negative. Arthritis is caused by an inflammatory response, which is how our body heals.
If you had significant instability and pain in your spine and went to see the surgeon for a solution, what would they do? They would perform spinal fusion surgery.
OR,
The other option is to learn to control your pain mechanism, enhance your core stiffness and stability, manage your pain for a few years, and eventually nature will perform its own spinal fusion.
Arthritis isn't necessarily always a bad thing. For some people a little bit of arthritis causes the stiffness they need to prevent their pain mechanism.
You will lose some mobility, and need to give up any dreams of becoming an Olympic gymnast. But a bit of mobility loss in exchange for taking away your pain is an amazing deal for most of us.
Don't Let a Silly Diagnosis Get You Down
So, as crazy as this may sound, perhaps 'degeneration' in your spine can sometimes even be a good thing?
The main takeaway to remember at the very least, is not to confuse ageing and healing with a disease.
You need a thorough assessment that can tease out which changes in your spine reflect a pathology that is causing pain, and therefor should be treated, versus our body just doing what it is supposed to under its current circumstances.
I hope you learnt something from this article and if you were someone who was terrified by a DDD diagnosis, I hope this has improved your outlook.
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If you know someone who has been told they have degenerative disc disease then please send them this article so they are not left feeling hopeless about a silly diagnosis.