I think you’re asking the wrong question. A better question would be “How do I resolve the pain that I believe is related to a degenerative lumbar spinal disc?” Because your question assumes two things that I’d challenge. Firstly you assume that your pain is directly related to the degeneration of your discs, and secondly you’re assuming that degeneration can in fact be cured – sorry, but it can’t. But don’t worry, just read on for a really practical approach to recovering from lower back pain and sciatica related to degenerative changes.
Degeneration and pain
There is a very poor association between the degree of degeneration found in XRays and MRI’s of the spine and actual pain – there are loads of people walking around with no pain at all who have advanced degeneration of the spine, and then there are many who have very moderate degeneration but have lots of pain (see the table below). Even if a doctor/osteopath/physio/chiropractor has told you that your pain is due to degeneration I would not necessarily believe it. The only way to be sure that a tissue (disc, ligament, muscle, tendon etc.) is the source of your symptoms is to inject that tissue with a local anaesthetic and then see if the pain lessens. Although even if it does, the clinician should undertake this test again, but this time inject you with water/saline solution (and not tell you that he/she is using an inert substance) and see whether you get the same pain relief – if you do, the effect is due to placebo and not due to injecting the tissue causing symptoms. You will not get this service from the UK’s NHS, and no private medical insurer will pay for it either. I believe the closest you can get to this is the clinical judgment of a really experienced clinician specialising in this field (can you think of anyone matching that description?)
Now, even if your degenerative spinal disc is a source of symptoms (and if it is, is this directly, or because of the irritation to surrounding tissues like a spinal nerve?), can treatment or any other intervention change the anatomy of your spinal discs? i.e. Can you reduce the degenerative changes? Well, the good news is that your body is constantly breaking things down and rebuilding them. Your discs are largely fibrocartilage (a bit like the cartilages in your knees) and as such they have chondroclasts which break down the old cartilage and remove it, and chondroblasts which make new cartilage. This process continues throughout life, although as we age most of us aren’t so good at making new healthy cartilage – this is part of the ageing process 🙁
If you have little bits of cartilage fraying off, they will be broken down and removed by chondroclasts and by other cells that are part of your immune system. Nothing lasts for ever – your body is constantly changing.
For rebuilding your discs, let me introduce you to the mechanism of “mechanotransduction“. Chondroblasts respond to the mechanical forces exerted upon them and the gelatinous substance they exist in – called extra-cellular matrix (ECM). They respond to these forces by laying down more fibres within the ECM. The orientation and number of these fibres is greatly influenced by the strain imposed on the tissue – this is mechanotransduction in action. So, if you want to build a stronger disc it’s important to optimally load the disc. Now what do I mean by optimally load? There’s the challenge. In theory, if you load the cartilage optimally, and give it optimal rest periods (it’s during rest that most of the re-building occurs) then it will get stronger. However, if you over-load it or under-load it, it will get weaker. How to know what’s optimal loading? Well, in the short-term you’ll have to start with pain, because if you want your discs to get stronger, that’s similar to saying you want them to heal. They will not heal if you do things that cause them to become inflamed. Inflammation leads to pain. So anything that you do that increases your pain will prevent healing (this is of course presuming that your pain is in fact related to your disc, and even if it isn’t this is a good maxim anyway when rehabilitating from any pain condition – see What’s the quickest way to fix my lower back pain / sciatica? for more on the rules of rehabilitation) .
I have a sense that it may seem like I’m over-complicating this. Sorry, I’m trying not to. And in an attempt to make it as clear as possible – as ever – here are my top tips:
- Don’t worry about degenerative changes – they are an inevitable part of life.
- Avoid doing things that aggravate your pain – either at the time or several hours (even a day) later.
- Move your lower back in all different directions and different ranges, and different frequencies (while still adhering to number 1. above).
- Repeat number 3 frequently.
This is all summarised in my catchphrase “Use it or Lose it, but Don’t abuse it.”
If you’d like to discuss your own problem in more detail and find out how to put steps 2-4 into practice for your particular back, please schedule a consultation in person or via skype through email@example.com