When people see degenerative change on an X-Ray or MRI, the tendency is to think your condition or symptoms are permanent without surgical intervention. Understand that these imaging results are just a snapshot in time of an ever-changing body. Do not let the words disc bulge, herniation, degeneration, or osteoarthritis scare you. Unless severe or chronic neurological symptoms (weakness, numbness, tingling) are being experienced, surgery is typically not necessary. Disc injuries and degeneration are only a result of using your body wrong over time unless a traumatic injury took place of course. If surgery or steroid injections were the routes taken, understand that most likely these issues will come back, or arrive at adjacent joints, because you never changed the CAUSE of the disc injury and degeneration… The way you are using that area of your body!
The disc is composed of two main parts, the outer annular fibers, and the inner, jelly-like, nucleus pulposis. Disc bulge and herniation occurs when pressure exceeds the strength of the annular fibers. There are 15-20 annular fibers that are concentrically oriented, and only the other ⅓ have a vascular and nervous supply! This means that most disc “bulges” are not even felt until the outer ⅓ of the disc is disrupted. When these fibers tear it allows more of the nucleus pulposis to enter the outer part of the disc causing a bulge. If all of the annular fibers tear then the nucleus pulposis will exit the disc. Upon exiting, this jelly-like material will swell causing even more pressure on the nerve root exiting the spinal column. Continuous tears of the annular fibers create degeneration of the disc and bony growth, closing down on nerve roots.
Good news! Discs heal! Because discs have a blood supply they are allowed to heal. The goal is to limit the actions causing the annular tearing, allowing for the discs to heal. Then you must change how you are stabilizing the area through that range of motion. Conservative care should always be the first plan of attack when attempting to come back from a disc injury unless severe neurological symptoms are being experienced such as weakness and incontinence.
When people hear degeneration, they tend to stop using that area altogether. This is the worst thing you could do! The rate of degeneration will continue to rise unless you fix the way you are using that area of the body. The goal of any degeneration process is to halt the progression. People tend to think degeneration is just a result of getting old, but actually this is just the result of using a body part inappropriately over time.
Dr. James Andrews, one of the most famous shoulder/elbow orthopedists, says, “If you want an excuse to operate on a pitcher’s throwing shoulder, take an MRI.” Dr. Andrews took an MRI of 31 asymptomatic professional baseball players to find that 90% had degeneration and abnormal rotator cuff tendons. These people had no pain and were performing at the top of their game! The amount of degeneration on an image does not dictate painful symptoms. “Degeneration” is the norm so do not label yourself based on the results of an image. The goal? Promote adaptation of your body towards ideal functional biomechanics. When correct movement patterns are mastered the risk of injury and rate of degeneration are drastically decreased.
80% of people will experience low back pain at some point in their life. Use this pain as a warning sign. Pain tells you that you are doing something wrong. People who ignore their painful symptoms facilitate the degeneration process and leave themselves at risk for injury. If you are not in pain, or your pain goes away, don’t assume this means you are using your body appropriately! Degeneration and disc injuries typically happen before pain arises. Whether you have, have had, or have not had back pain, make sure you know that your body is functioning appropriately to limit future degeneration and preserve the health of your joints!
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