What is Degenerative Disc Disease and Does it Matter | Podcast Ep. 129

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are talking about the discs. Disc degeneration. Does it matter? Why does it matter? And what does the research say? Just another topic that all of us see day in and day out in practice. And I want to put some context around it. So this week we are talking all about lumbar discs. I am actually sitting. It is Friday morning, bright and early. I am hopping on a plane to head to Kansas City in just an hour or two to attend the Forward Thinking Chiropractic alliance first seminar. I'm speaking three times. Somehow I got my arm twisted into that. So I'm excited to get out there and hopefully if you're listening to this on Monday, hopefully you're back at, back at practice, on your way to the office and had a great time and we were able to hook up and meet up. So I'm pumped about that. Thanks, Bobby, for putting it together. I'm looking forward to it. It's gonna be a great event. But today we are talking about lumbar discs and I wanted to touch on a paper from the Theoretical Biology and Medical Modeling Journal. You know, one that we talk about each and every week here on the Evidence Based Chiropractor podcast. But it's an interesting study. It was titled Disc Degeneration implies Low Back pain. Again, disc degeneration implies low back pain. And you could find this study also in the show notes. So the gist of it is this. We all know lumbar disc degeneration. It's a process that's directly associated with age. You live long enough, you're gonna have degenerative changes. There's just no question about it. And as we age, that instantaneous axis of rotation migrates posterior across the intervertebral disc and it loads the facet joints. And additionally, the disc becomes sensitized as nociceptive fibers infiltrate the annulus fibrosus. So as we age, our instantaneous axis of rotation migrates posteriorly. What that does is it places additional stress and strain on the facet joints. This is quite often why we see facet disease, facet arthropathy, however, you want to define that in people who are, let's say, seniors. Additionally, what the research has shown us over time is that the disc is the blood supply kind of stinks when we're younger. Additionally, the nerve supply isn't so hot. But as we age, the nociceptive very, very small nerve fibers, they infiltrate, they start to become much more prevalent in the annulus. So when there is or are micro tears, when there are degenerative changes, when there is stress and even micro trauma to the disc, it's a lot easier to feel pain because now literally you have the pain sensitive fibers present that weren't there. It's all part of the aging process. And this study provided some valuable insight into the relationship between disc degeneration and low back pain. And their analysis indicated that the pain associated with long term degenerative changes could be episodic, which is why asymptomatic patients may present with degenerative changes. And this is what we know to be true as well. Right? You know, almost everybody's gonna have degenerative changes, yet only a certain subset of people are in pain. Not every Single person above 65 has back pain 365 days a year, thank God. But what we see is episodic nature of back pain. As we age. Degenerative disc disease can often be treated non surgically, as we well know. And nutrient transfer across the disc is facilitated through motion. In my opinion, this is where the literature has started to show how valuable the adjustment or spinal manipulation can be. Because that motion of the joint that facilitated motion, whether it's by hand or by instrument, it actually helps nutrient transfer across the disc. That is one mechanism by which chiropractic manipulation, in my opinion, has been shown to reduce the pain associated with disc degeneration. It's good to get segmental motion. We know it opens up and gaps the facet joints. We know that it certainly has an effect on disc pressures. We know that on flexion distraction technique, you're putting motion into that segment directly. Heck, with a Gonstead Thompson drop or any other technique, it's really about getting that segmental motion. So let's take a look at a few quotes of what the researchers found and then we could put it into context, into daily practice. So these researchers found lumbar intervertebral disc degeneration is nearly ubiquitous among patients with symptomatic back pain. Basically, if you have back pain, there's probably disc degeneration creeping around the corner or already there. In that case, the researchers also found the natural history of low back pain shows not only age dependence, but but also a pattern of remission and recurrence, which is different from other irreversible clinical outcomes such as cancer, stroke, or heart attack. So as they're talking about here, low back pain, hey, it can come and go. There's episodic, there's remission there's recurrence, and that is different than many other disease processes that are seen in the human body. The researchers also found disc generation is well underway and most discernible among the young and continuously rises among the older adult population. As we touched on at the beginning, the older you get, the higher likelihood, close to 100%, you're gonna see some degenerative change taking place in that spine normal part of the aging process. And finally, the researchers found, quote, in summary, the complexity of low back pain epidemiology results from the coexistence of two different timescales, the slow dynamics of disc degeneration and the fast dynamics of pain recurrence. This is a cool quote because I think it really puts into play what we see every day, right? People have degenerative processes throughout time. But getting back to chiropractic, how adaptable is the body, right? We see people in these bizarre postures, people with forward flexed posture and all sorts of compensation techniques and devices, even if they don't know they're doing it. High shoulders, hip hike, you name it. We see the body compensating for challenges that it's occurring under the weight of gravity. And that degenerative process is exceptionally slow. It takes decades upon decades for degenerative changes typically to take hold, right? I mean, you live, your skeletal maturity may be in your late teens, mid-20s, and with that, you're still developing for decades. Then you have a period where things are, let's say, stable. And then you see things start to traverse into the degenerative change category as you continue to age. But you take that long game, right? It plays out over the course of decades of people's lives. And we see these short bouts of extreme pain. That's that fast dynamics of pain recurrence as they're talking about with this paper. And it's an interesting dichotomy, the slow degenerative change process mixed in with these fast dynamics of pain recurrence. Now, the great thing about it, we touch on it each and every week here on the Evidence based Chiropractor podcast and is for a vast majority of those painful episodes, big time intervention such as surgery is unnecessary for a vast majority of individuals. Chiropractic care should and could be their number one choice. The literature showcases that time and time again. And if we put this in the context of that landmark study from the New England Journal of medicine in the mid-90s, they looked at asymptomatic patients and did MRIs on a ton of people. And basically, what they found was over 50% of the asymptomatic people had degenerative changes. 20 something, some odd percent, I believe, had disc issues. Certain percentage had spinal stenosis. So it really opened the eyes of a lot of the medical community that, hey, making decisions of surgery based off a static picture might not be the best idea. It's about function and it's certainly you can have people with degenerative change. You can have people with findings on an MRI that don't require, let's say aggressive intervention such as surgery or injection. So it's about again, the context of their pain and ultimately their function. So this study kind of goes hand in hand with that, showcasing, hey, you know, you can have findings in bay be asymptomatic. However, when you do have symptomatology, when people do have pain, well, nine times out of 10, whatever the case may be a very high percentage of the time, nearly every time, degenerative changes are underlying the painful syndromes. And when we get down to a patient education standpoint, I think it's about utilizing research like this to have great conversations, patient centric conversations with the people that come into your practice. So letting them know that just because they're getting old or just because they have pain right now, it doesn't mean that their spine is fragile. It doesn't mean that they're doomed to pain forever. I think there's a lot of misnomers with that. So when you can showcase to a patient, hey, you have some degenerative changes here and here. This is why we are going to do XYZ in the office to regain that function. But don't be overly concerned with what you're seeing on the picture. We wanna monitor that and make sure that we are doing our best to keep your funct as high as possible. Pain relief job one with that, right? Nobody's functioning at their highest level if they're wincing in pain. But the secondary component is making sure they are able to do the things they love with the people they love. So when you're having conversations with the patients that come into your practice or if they're getting opinions elsewhere, right. Many times they might have an MRI and somebody else has scared the you know what out of them. I know, I've seen that hundreds of times, literally. It's important to be able to frame that in a way that empowers the patient, has them understand the context of what's going on on the picture, how it relates to their daily life and how ultimately, if possible, you can help get them back on track, get their life back, and ultimately live a very high quality of life. So, all things to consider, disc degeneration. Nearly everybody's going to get it, but it doesn't mean that that you are doomed to a life of pain. So I hope you have a great week in practice. If you have an opportunity. I love feedback, ratings and reviews on itunes. So please let us know how we're doing, give us a rating, feedback or review. You can always email me, jeff the evidencebasedchiropractor.com and I will talk to you next week. Have a great week in practice and I will talk to you soon.

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