Understanding Disc Degeneration: Causes, Effects, Treatments, and Holistic Prevention Strategies

Let's talk about spinal disc degeneration. You have been led to believe that degeneration is due to the ravages of time and there's nothing that we can do about it, sorry that's what time does. There is a degree of truth to that. However, I have taken and evaluated a lot of x rays, and I've seen some 70 year old spines that look better than mine. I have also seen disc degeneration in a 16 year old. Moreover, if disc degeneration was due to age of a person alone, then we should see uniform degeneration throughout the spine, because all the bones are the same age. However, the majority of the time, we will see a focal area of degeneration, with the adjacent areas totally normal. To me, that indicates the degenerating area is aging faster than it should be. So why would one area show signs of accelerated aging in the spine from disc degeneration? My hope is that by the end of this article, you will understand what causes disc degeneration, its effects on the body, how to diagnose and treat it, and how to prevent it.

What is disc degeneration?

In between each of your vertebrae, there are specialized ligamentous cushions called intervertebral discs. Many people and even some doctors think that the discs are for shock absorption, but that actually is not true. We now know that what really absorbs shock in our spines are our curves. In a normal spine, we should not see curves from the front view, but from the side we should, and curves are good... as long as they are within normal limits. Generally that means that the neck curve is going toward the nose, the midback is away from the nose and the lower back is toward the nose but more elliptical.

These normal spinal curvatures from the side view displayed above are what actually absorb shock. If we were to lose those normal curvatures, then there is abnormal force on the spine where the discs then have to absorb the shock. This abnormal wear and tear will cause the discs to dehydrate, triggering and accelerating the degenerative process.

How do we lose normal curvature? TRAUMA. Whether it's macro-trauma like big slips falls and accidents, or microtrauma like poor position for long periods of time -- Trauma causes a "jam" or shift in the normal alignment of a segment of the spine called a subluxation. Subluxations will reduce spatial awareness in the body and initiates the degenerative process in the spine!

What happens in the body when this occurs?

When the discs start to dehydrate and then degenerate, a multitude of things happen. Firstly, we will see that the loss of normal curvature continues, putting our spines in a weakened position and potentially setting us up for reinjury. Another is that the area becomes stiff and less mobile. This is a huge problem when it comes to our body's proprioception (self awareness in space) and causes us to poorly perceive our environment. If we have poor perception of our environment, we will have poor adaptation and action to our environment. This could contribute to an array of issues from balance and coordination to altered sensory and organ function to stress response. There's a previous blog that goes into more detail about that, but just... better awareness is better for our brain and it is highly correlated with proper movement of EACH segment of the spine. If we do not have full range of motion in our 6 degrees of movement, we will lose the ability to build collagen in our bodies. Without collagen build up in our tissues, we will lose elasticity and become unstable. Instability will lead to bony calcification to occur as our body's last ditch effort to try and stabilize us.

Another interesting thing that happens with degeneration is that the disc becomes a pain generator. Normally, the intervertebral disc does not have vascularity, and that's for good reason. It's not supposed to, because if something has blood flow, then a lack of blood flow to that place can cause pain and symptoms and can expose to bacteria infiltration. The crazy thing is that when the disc degenerates, the bone degenerates. If this continues, then over time the vertebrae above and below it will start to increase blood vascularity and nerve supply, and can start to itself generate pain. This also has a feedback loop process in that this then becomes a cycle that does not get better on its own with time and will continue to degenerate if the damage is not addressed.

If that weren't enough, local changes in the disc affects the systemic inflammatory response.

How is it diagnosed?

The only way to diagnose disc degeneration is through imaging. There are 3 main types of imaging: CT, MRI, and X Ray. CT is most expensive, highest radiation. MRI is the most sensitive for degeneration as it can view bone and soft tissue, is costly, takes the longest, and has no radiation. X Ray is the fastest and most affordable way to assess bony changes. Chiropractors prefer x ray because it also allows us to see the spinal behavior under forces of gravity. As a Gonstead practitioner, I take full spine x rays when necessary, because I can take detailed measurements and better understand how the body has adapted to certain stresses, and everyone adapts differently! I feel like the spine is as unique as a fingerprint, which makes it an essential component in personalized care.

How is it treated?

Chiropractic is phenomenal at addressing neuromechanical dysfunction of the spine. The Gonstead technique focuses on restoring the normal integrity of the disc. I am lucky enough to attend a special seminar where the best of the best Gonstead minds come and speak on a singular topic for a whole weekend and one happened to be on the disc. This article is just scratching the surface of the depth in which they cover the intricacies of what happens to the body. One of my biggest takeaways was that "biomechanical trumps neurological." This means that how we are able to adjust the spine with neutrality, specificity, and the care and condition of the disc in mind has positive neurological effects locally and globally. It's crazy how the neurology of the body is influenced through such a seemingly simple action of an adjustment! (If you want me to go over the details of what happens neurologically with an adjustment, I'll be happy to!) The Gonstead approach is among the best in assessing the traumatized disc that needs to be adjusted and providing the most effective and precise corrective adjustment. It breaks the degenerative cycle through focused movement and helps to restore normal biomechanics which positively influences neurology and restores normal function.

Other great additions to chiropractic adjustments include modalities like curve corrective traction, physical therapy exercises that include targeted load with recoil to restore strength and flexibility, balance exercises, and anti-inflammatory diet.

I recently also came across promising research relating to low level laser treatments in helping with osteoarthritis and pain by stimulating mitochondrial ATP production. The lasers referenced in the studies were within the light spectrum, short wavelength, pulsing, and not heat producing (like infrared). More on that in a future post too =).

If you didn't want to go the holistic route, other alternative treatments would be NSAID or pain medication, steroid injections, or surgery. Generally speaking the less invasive (like an adjustment), the less side effects and the more invasive the more side effects/complications. They definitely have a place in healthcare and when are needed we are glad that they are there, but I would try less invasive and go more invasive as you need to achieve the result you want.

How do I prevent disc degeneration?

If trauma and immobilization trigger and contribute to spinal degeneration, then prevention is simple: don't get hurt and keep moving! Getting injured is kind of inevitable... Especially if you think of the nature of how we develop. Prevention starts before problems occur and birth is the first trauma that we experience. Also, according to https://www.childrenssafetynetwork.org/infographics/falls-children-youth-hospitalizations the average number of fall hospitalizations under 5 years old is 10,000! So, we fall a lot. Even though getting hurt is unavoidable, strengthening our bodies to minimize injury and treating injuries immediately are totally viable strategies, and should be started as early as possible. That is why conservative and focused chiropractic care for babies and children is really important, because our formative years will dictate how we adapt and develop as we mature.

In terms of exercise and activity, we just want to have full body exercise and activity that is appropriate for our stage of development. For example, tummy time from day 1 in infancy to 4-6 months, transition to sitting and crawling to 6-8 months, transition to walking to 12-18 months, transition to running. It cannot be emphasized enough to have your babies crawl for as long as possible! A lot of functional movement issues and spinal curve issues have roots in childhood development. Babies need to feel gravity on their joints in order to develop proper strength and resilience, and symmetrically, and tummy time and crawling stages are KEY.

Credit: Pathways Foundation https://www.instagram.com/pathwaysorg/p/C3I7KlDPT78/

Once we get to walking and running, fun variations like bear crawling, coordination activities like pee wee sports, dancing, climbing, swimming, etc are great for further developing coordination, strength and stability to the spine and body. If you follow Gabrielle Lyon, DO then you know that building and maintaining muscle is a key indicator for longevity and healthspan (not to be confused with lifespan).

My best advice here is to find an activity or exercise that you like, and make it part of your daily routine to enjoy... like a treat to yourself. If you haven't found something you love yet, or you don't like exercise but just want to get it over with, HIIT is for you. It's 15-20 min of your day to basically burn yourself out to exhaustion. It's got a ton of research around the benefits metabolically. I'd alternate it with a 15-20 min of yoga poses and stretches to add sustained hold of positions to add flexibility and sustained strength of different muscles. Also of note is for women, since we have a more complex hormone cycle that changes our needs for exercise in our cycle, we would probably benefit from having some days with TABATA as well in weeks 1-2 and in the last 10-14 days of cycle going for only yoga and stretches.

If you are starting your prevention program a little later, that's okay! My favorite saying is "the best time to start was yesterday, but the second best time to start is now." For anyone beginning their journey 30 and above, the first thing is to see where your starting point is. That would be with a comprehensive evaluation that includes imaging. Then knowing where you are helps you to better know what your needs and goals should be and how to reach them according to the pace that you want. A chiropractor is ideal in initial evaluation as well as creating a plan to 1. slow aging process 2. maintain 3. prevent. It will take a little more work, but we are pretty good at recommending habit and lifestyle changes as big or as bite size as needed for you. Chiropractic care is in my opinion a gatekept secret to natural health and longevity that needs to be shared so the 5-7% of general population who are under regular chiropractic care aren't thriving at 100 by themselves.

SUMMARY

Spinal degeneration is a condition describing the health of the intervertebral disc. It is not due to age of a person, but age of a problem that's been there. The problem is initiated by trauma. The degenerative process occurs due to abnormal pressure and forces on the disc that triggers dehydration, loss of motion, and instability. If not resolved over time, it will degenerate and the bony vertebrae will degenerate with it. The bony degeneration will result in increased pain along with bony weakness, further disc dehydration, and contribute to systemic inflammation in the body.

Since degeneration is a time sensitive issue and does not resolve on its own, it's best to take care of small issues before they become big ones. Get assessed to know what your current status is, because knowing where your are starting is essential in finding the path to where you want to finish. Chiropractors are well equipped to help you from any stage and age to get you out of pain and into prevention. Sooner is better, and no better time than now!