Ask a Physical Therapist: Degenerative Disk Disease

Question: What is low back degenerative disc disease and how can core strengthening help with this?

Answer:
Degenerative disc disease (DDD) is the narrowing of disc height and space between the vertebra, leading to increased bone on bone loading of the joints. This can be caused by normal wear and tear over time or trauma. Our discs are filled with a jelly-like substance in the middle called the nucleus pulposus. The jelly disc is surrounded and supported by ligament-like structures called anulus fibrosus. These structures create a nice, squishy shock absorbing system for the spine. When the surrounding ligaments become weak or torn, they can no longer contain the inner jelly substance causing it to break down and sometimes leak out. The different levels of breakdown are known as disc degeneration, disc bulge, herniated disc or disc protrusion (see illustration). The symptoms of DDD can vary based on severity and range of degeneration. A person may experience localized back pain, but many times the pain will radiate down the legs due to nerve impingement or pinching. They may also experience numbness, tingling or weakness down the legs with more severe cases.

Core stabilization exercises aim to strengthen the supportive musculature of the trunk and hips. By strengthening these muscle groups, there is more spinal support and as a result pressure is taken off of the joints and nerves leading to less painful loading of the spine. Performing gentle pelvic tilts with 5 to 10 second holds while lying on your back with the knees bent up can help re-train the deep stabilization muscles which become inhibited with back pain. Another starting option is to sit on a physioball and perform slow, gentle pelvic circles while keeping the deep stabilizers engaged. To address the spinal extensors, performing “pointer dogs” by raising opposite arm and leg while keeping your back and hips level can also be beneficial.

At times, when a person has a hard time tolerating basic walking or land-based exercises due to symptoms, working in a pool is a good alternative. The buoyancy of the water helps unload the irritated joints and takes pressure off the nerves. Basic walking exercises, hamstring stretches, gentle cycling in the pool corner, and simply hanging in deep water with a noodle under your arms can provide decompression and provide an environment to aide in strengthening while protecting an irritated back. For more specific information and assessment of DDD or developing an individualized home exercise program, contact our clinic to work with one of our physical therapists.

Spinal disc make-up Spine

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