What changed? Chronic back and neck pain used to be a condition that impacted primarily the elderly from what was thought to be the inevitable result of advanced age; today, younger and younger patients present with Degenerative Joint Disease (DJD).
When I began practice over 30 years ago degenerative changes of the spine were not even considered to be a realistic possibility in anyone under the age of 60. Sure, there were occasional exceptions such as the retired Major in his 50’s with over 800 career parachute jumps but these instances were rare. In a few short decades the incidence of true degenerative findings in younger patients has increased alarmingly. What has changed?
First, it is helpful to describe the meaning of the phrase Degenerative Disc Disease (DDD) or Degenerative Joint Disease (DJD). Patients often harbor hazy notions that this somehow means the bone has eroded or worn away, and that the spinal discs have in some way dissolved or disintegrated. Actually, the diagnosis is made by 3 specific radiographic findings: the disc has begun to dry out as can be determined by how white it is on the image (desiccation), the dry disc has begun to lose height resulting in adjacent vertebra becoming closer together (stenosis), and finally the stress on the bone and ligaments which one would at first suppose would wear down the bone actually results in a buildup of bone (bone spurs) much in the same way that stress to the skin on the palm of your hand results in a buildup of skin called a callous. With bone this calcium buildup is known as osteoarthritis.
So, if degeneration means a progressive dryness, thinness, and calcium build-up that leads to chronic back and neck pain, then steps taken to prevent or reverse this and rehydrate the disc, restore the lost height, and eliminate the stress on the joint would help neck and back pain. But, why does a disc degenerate?
What Causes a Spinal Disc to Dry Out?
To understand why a spinal disc would dry out it is first necessary to understand some of the basic anatomy of a disc. A disc resembles in some ways an automobile tire sandwiched between two spinal vertebra. However, the rubbery part on the outside is really a fibrous, ligamentous-type tissue, and the inside, rather than being filled with air like a tire, is really filled with a jelly-like protein substance that is designed to absorb shock. There are no blood vessels that penetrate the rubbery outside layers to supply oxygen and nutrition to these living cells. Instead, the intervertebral discs depend upon normal motion, or a pumping action, to move fluid and blood flow through them which arrives through the end-plates of the vertebra above and below the disc. Anything that hinders the normal motion or pumping action, or lessens the ability of the blood to deliver oxygen or nutrition compromises the health of the disc tissue. A healthy disc is a bit like a hockey puck in that it nearly can’t be hurt, but a dry degenerating disc is injured again and again at every turn each injury further restricting the joint motion and limiting the pumping action which accelerates the process.
Nutritional Considerations
Unlike past generations, in our modern society much of the food we eat has been processed and now contains preservatives and other additives. Foods are canned, frozen, or micro-waved all of which compromises some of the nutritional value. Worse, much of what we consume has been exposed to herbicides and pesticides further challenging our metabolic processes. These same herbicides and pesticides contaminate our ground water as well. Other environmental pollutants found in our air and water such as emissions from automobiles and industries, radiation, asbestos, and many others all contribute to metabolic stress. Smoking, alcohol, and pharmaceuticals are also contributing factors.
The answer here is to strive to have a healthy diet. A donut and a cup of coffee is not a nutritious breakfast, and super-sized fries and a soft drink is not a nutritious lunch. If your idea of preparing dinner is any meal that requires more than 4 minutes in the microwave you’re asking for trouble. If essential nutrients are not in your diet how can they find their way into the disc and other cells of your body?
These same poor health habits also contribute to the obesity epidemic in the modern nations of the world. Excessive weight also stresses the disc.
