Back pain from degenerative disc disease or disc herniation is caused by a combination of injury, a change in the biomechanics of the spine (postural problems) and accelerated degenerative processes.
This leads to instability and inflammation/irritation.
Instability leads to muscle guarding/stiffness, muscle fatigue and finally spasm. An inflamed disc reproduces pain internally, in vertebral bones involved, in the now weight bearing facet joints (articulations between vertebrae), as well as with the spinal nerves involved. Nerve pain can be quite severe and debilitating, affecting walking, arm and hand motions, and simple range of motion. Both the instability and the inflammation must be addressed for the back pain treatment to be effective.
The treatments for degenerative disc disease are either passive (done to the patient) or active (done by the patient). Usually a combination of treatments are used to provide relief from the symptoms. Passive treatments are rarely effective on their own—some active component, such as exercise, is almost always required.
Passive Lower Back Pain Treatments
If you have low back pain from degenerative disc disease, below are some common treatments.
Typical pain medications used to treat the low back pain include nonsteroidal anti-inflammatory drugs (ibuprofen, acetaminophen) oral steroids, narcotic drugs (Fentanyl, Hydrocodone, Oxycodone) and muscle relaxants (Chlorzoxazone, Baclofen.) Each type of medication has strengths, limitations, and risks, and the patient’s particular low-back problem and overall health will determine which pain reliever, if any, is indicated. This treatment is simply covering up the pain caused by degeneration. Nothing was done to stop further degeneration and more pain long term.
An epidural injection into the spine delivers steroids and or painkillers that can provide temporary low back pain relief by decreasing inflammation and reducing pain sensitivity in the painful area. There are a host of potential risks involved in getting epidurals including paralysis, allergic reactions, and tissue necrosis. Again, this may bring temporary relief, but does little to address the root cause of the pain.
Transcutaneous Electrical Nerve Stimulators deliver mild electrical stimulation that activates the muscle motor unit causing contractions and activation of sensory receptors that send proprioceptive signals to the brain crowding out pain signals from the lower back. This treatment addresses only soft tissue aggravation but does nothing to prevent the degeneration from progressing.
High frequency sound waves cause oscillation of the molecules that comprise the tissues which warms the area bringing increased blood flow. The blood brings more nutrients, oxygen and a reduction of inflammation provides temporary relief from acute discomfort and can encourage healing. Like the TENS units, this is a soft tissue relief mechanism which needs to be coupled with other treatments for best results.
Therapeutic low back massage provides low back pain relief by reducing muscle stiffness, reducing muscle spasms, increasing range of motion, and raising endorphin levels in the body. It moves tissue fluids out of inflamed areas and increases fresh blood flow to the area. Massage can sometimes trigger back spasms if guarding muscles are a body response to the pain rather than a symptom.
Manual adjusting by a chiropractor who is the only qualified health professional to provide this service, provides lower back pain relief by realigning the vertebral segments and restoring proper biomechanical balance.
This in turn takes pressure off sensitive neurological tissue, increases range of motion, restores blood flow, reduces muscle tension, and creates a series of chemical reactions in the body (such as endorphin release) that act as natural painkillers. This treatment method is very effective in helping people with low back pain.
Coupled with TENS, ultrasound, therapeutic massage and spinal decompression, patients have the best prognosis to get out of pain quickly and to slow the progress of further degeneration.
Computerized spinal decompression traction
Spinal decompression therapy involves stretching the spine, using a traction table or similar motorized device, with the goal of relieving back pain, neck pain, and/or leg pain. Spinal decompression devices use the same basic principle of spinal traction that has been offered by chiropractors, and to a lesser degree osteopaths.
Computerized spinal decompression traction is a type of traction therapy applied to the spine to create a negative intradiscal pressure (traction) to promote retraction or repositioning of the herniated or bulging disc material.
This lower pressure in the disc pulls fluids from the surrounding tissues which causes an influx of healing nutrients and other substances into the disc.
Instead of straight traction, this method pulses between higher and lower weights in a gentle pumping action which increased disc height while preventing the supporting muscles from painfully guarding. Straight traction is known to cause adverse muscle reactions.
In a landmark study of severe disc herniation by Gose, & Naguszewski at the University of Illinois at Chicago, 778 patients from 22 medical centers underwent spinal decompression traction. The success rate was 71% and was defined as any patient decreasing his pain from a 5 (worst pain possible, to a 0 or 1 (no pain or minimal pain).
Of the remaining patients, all but one experienced significant reductions in pain at a 2 on the pain scale. Decompression traction is one of the best low back treatments especially for the chronic and hard to treat types of low back pain! Coupled with chiropractic adjustments, TENS, ultrasound, therapeutic massage, and ice/heating, this is far more effective than traditional drugs and surgery in terms of eliminating pain, preventing reoccurrences, and slowing further degeneration.
In addition, heat and/or ice therapy, acupuncture, behavioral therapy, and other therapies often provide enough low back pain relief to allow the patient to progress with his or her exercise and rehabilitation program.
Active Lower Back Pain Treatments
Some active treatments for lower back pain can include:
Physical Therapy and Exercise
For the vast majority of patients, the only way to achieve long-term healing is active exercise, which usually includes a combination of strengthening, stretching and low-impact aerobic exercise. PT’s can work with the patient to strengthen supportive structures like muscles, and reduce muscle tightness through flexibility work.
For patients who smoke, doctors recommend quitting smoking to improve blood circulation and healing. Chronic tobacco use is closely linked to chronic pain in the lower back as well as global body inflammation increasing pain sensitivity throughout the entire body.
Losing weight can reduce low back pain in overweight people by lessening the amount of stress on the low back’s muscles, ligaments and especially the discs. Losing the extra weight will help all the joints in the body to bear less weight increasing their functional lives. Diets like the Ketogenic Diet are great options to jumpstart weight loss!
Proper lifting techniques, ergonomic furniture, supportive footwear, and avoiding static posture for prolonged periods of time can help take pressure off the low back.
Stretching and flexibility
Chronically tight muscles play tug of war with the back. The spine is unable to maintain the correct posture which leads to poor posture irritating soft tissue, causing spasms, loss of range of motion, and increased degenerative processes.
So which treatment is most effective?
It is always important for the patient to be involved in his or her treatment and recovery. Studies show that a special combination of active and passive approaches should be used.
During the acute phase of injury icing, ultrasound and light force chiropractic adjustments work best. Many pain medications can relieve pain, but they can have addictive properties, and don’t allow you to gauge the progress you are making with other treatments.
Some drugs also slow the healing process which prolongs the problem. Once the area has been stabilized and is no longer acute, decompression traction and the active treatments such as stretching, exercise, and PT may be utilized. Regular exercise programs, maintaining a healthy weight, not smoking, working on posture through stretching and ergonomics, can help prevent future problems!
If you have more chronic issues, regular chiropractic care, decompression traction, and the active treatments mentioned above seem to slow or even arrest further degeneration which leads to worse pain.
Everyone can benefit from regular chiropractic care as well as maintenance decompression traction. Even individuals with no apparent problems can work to maintain a healthy spine to avoid future problems associated with aging. Maintaining a healthy spine requires work just like proper brushing, flossing and dental cleaning all maintain the health of your teeth.
By utilizing this approach back pain, muscle stiffness, and degenerative spinal conditions can be avoided in a “healthy person.”
If you are experiencing stubborn back pain from acute injury or degenerative processes, chiropractic adjustments and decompression traction can help manage or eliminate the pain. Even in very severe cases, it can successfully manage pain and postpone or avoid surgery altogether!
Is it time for you to consider chiropractic care? Consider calling us today to see if it’s the right fit for you.