Because annular tears accumulate and cause disc degeneration, several spine centers are attempting to develop methods to repair annular tears. To repair or prevent tears, they’re studying bio-adhesive glues, fibrin, disc sealants, and mechanical anchors. Nutritionists are optimizing diets to maximize disc health, and biomechanical experts focus on minimizing mechanical forces, which damage discs. All of this is done in an attempt to treat degenerative disc disease.
Unfortunately, repairing annular tears presents a financial dilemma for spine surgeons, as it interferes with profitable therapies, injections, and surgeries.
Options to Treat Degenerative Disc Disease
Independent Exercises and Physical Therapy
The first and most common way to treat degenerative disc disease is physical therapy and exercise. You can perform these exercises independently or with the help of physical therapists, trainers, or exercise physiologists.
When performing exercises, remember to avoid the two movements that worsen degenerative disc disease: flexing forward and rotating or twisting.
Correct Exercises and Stretches
Two activities hurt discs: Forward flexion and twisting. Because of this, it’s important to avoid bending forward to touch your toes, the windmill, and sit-ups.
During exercises, remember that your discs are in the front of your spine, not the back of your spine. This will help you remember to stick to the following guidelines when performing exercises:
- Avoid forward flexing, because this movement causes compression forces on discs.
- Avoid spine rotation or twisting, because this causes shear forces that lead to annular tears.
- When lifting, hold things close to your core. This will also minimize compressive forces on discs.
Why walking and running are great exercises
The benefits of walking and running to treat degenerative disc disease include:
- These exercises can be done anywhere, without cost.
- They are known to strengthen the heart and lungs.
- These activities strengthen legs. When legs are strong, one instinctively lifts with their legs instead of their back, protecting their discs.
- Walking and running nourish discs. This is because these exercises cause gentle up and down movement leading to the generation of hydrostatic forces. Alternating hydrostatic forces promote disc osmosis through the disc’s endplates. These endplates, located above and below each disc, nourish discs. This is necessary because discs have little to no blood vessels. This forces them to rely on osmosis through endplates to transfer nourishment into discs and metabolic waste out of discs.
Avoid prolonged sitting, whether it’s watching a movie or going for a long car ride because this prevents disc osmosis. If you’re driving, it’s a good idea to pull your car over and walk around every 30 minutes. In your daily routine, you should get up and walk for 2-4 minutes to promote disc osmosis.
In summary, independent exercises are free and you can perform them anywhere. This makes them a great option to treat degenerative disc disease. All therapy and exercise sessions should include teaching independent exercises.
Alternative Treatments for Degenerative Disc Disease
Acupuncture, herbal remedies, and biofeedback
Alternative ways to treat degenerative disc disease have been in existence for thousands of years, so it’s unfair to consider them alternative, but this is how they’re classified by medical boards. Although no evidence supports their ability to successfully treat degenerative disc disease, the evidence does suggest that alternative treatments minimize pain, allowing degenerative disc disease sufferers to cope with symptoms and increase daily activities.
Vitamins and herbal remedies, such as devil’s claw, white willow bark, fish oil, and vitamin E interact with some medicines, so you should consult with your physician before taking any alternative treatments. Remedies containing vitamin E or fish oil thin blood, so you should stop taking these before surgery or injections.
Spinal Manipulation
Chiropractic manipulation may help maintain spine motion and provide temporary relief, allowing one to return to work or activities. No evidence shows that chiropractic manipulation can truly treat degenerative disc disease. There are many chiropractic techniques, but spinal adjustment or manipulation is the most common, and it’s important to note that research shows twisting manipulation tears spine discs.
Occasionally chiropractors recommend a series of chiropractic appointments to treat your symptoms. Research confirms that lumbar traction has no ability to return discs to normal position, nor does it cause a negative pressure within the disc to help resorb bulges or herniations as purported.
One study evaluating lumbar traction showed that lumbar discs experienced no negative forces to allow it to pull disc bulges back into normal position until after the cadaver bodies disarticulated. In other words, traction has no value in helping discs.
Because the majority of people suffering from low back pain experience relief naturally within six months, if those patients happen to be undergoing chiropractic manipulation, traction, or therapy, they may erroneously attribute their relief to the treatment, when it actually occurred naturally.
Although no research supports the ability of traction to treat degenerative disc disease, some chiropractors and physicians still enroll patients in traction programs.
Before trying spinal manipulation or any chiropractic technique, your doctor should confirm that your spine is stable. You can only confirm stability by standing upright, flexing forward then extending backward, and comparing X-rays taken while you are in these positions. If the two x-rays demonstrate a significant shift of one vertebra relative to another vertebra, this indicates instability. If your spine is unstable, it should not be manipulated.
NSAIDs, Anti-depressants, and Other Medications
Although no medication can treat degenerative disc disease or annular tears, some medicines may provide symptomatic relief.
Commonly used Degenerative disc disease medicines:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). This type of medication may provide relief by decreasing inflammation caused by disc tears.
- Corticosteroids. These medications are able to provide symptomatic relief by stopping inflammation.
- Acetaminophen. This medication does not help reduce inflammation. Instead, it blocks the brain’s perception of pain, which can provide temporary relief. You should limit your intake of acetaminophen to 4000 mg/day to protect your liver.
- Anti-depressants. This medication increases your body’s production of endorphins, which is a natural painkiller. This may also treat insomnia, which affects many suffering from chronic pain.
- Muscle relaxants. As the name describes, this medication helps relax muscles. Muscle relaxers treat degenerative disc disease by relaxing muscle spasms caused by this condition. However, muscle spasms occur because torn discs leak nucleus pulposus gel onto adjacent spinal nerves, stimulating the muscles.
- Pain Medications. This includes Tramadol and Opioids. It’s best to avoid these medications except as a last resort because of their addictive potential.
- Neuropathic Agents. These medications treat nerve pain.
Spinal Injections for Degenerative Disc Disease
Epidural Steroid Injections
Epidural steroids have never been approved by the FDA to treat degenerative disc disease, but they are still the most commonly performed spine treatment. No scientific evidence supports their ability to help low back pain, however, they have a limited ability to treat arm and leg radiculopathy pain.
Steroids were only approved by the FDA for injection into joints to treat joint arthritis, but not for injection into the epidural space. However, epidurals are minimally invasive and were once the only treatment able to provide partial relief from pain caused by epidural inflammation.
The recent development of disc biologic sealants may decrease the overall national number of epidural injections because disc sealants stop discs from leaking, and this stops epidural inflammation.
In a meta-analysis published in the Annals of Internal Medicine in which every epidural injection study was analyzed, it was concluded that epidurals do not successfully treat chronic low back pain. The FDA published a warning against the use of epidural injections of corticosteroids, as repeated epidural steroids may cause damage.
Facet Joint Injections
A more accurate name for these injections is Zygapophyseal joint injections. These injections have no proven ability to provide sustained pain relief; they can only diagnose z-joint pain.
If z-joint pain is confirmed, treatment options include cutting the facet joint sensory nerves by burning them with Medial Branch Radiofrequency Neurotomy, or experimental techniques to regenerate z-joints by injecting them with platelet-rich plasma (PRP).
The best way to treat pain associated with degenerative disc disease is to precisely located and heal annular tears. Unfortunately, most common diagnostic tests and medications recommended for this condition are unable to treat this underlying cause. This is why if you’re suffering from back pain related to degenerative disc disease, a treatment such as the Discseel® Procedure, which targets annular tears, is your best option.
