21 0686 2040
Disc Disease – Back Pain
Disc disease, or disc degeneration, is a condition caused by the degeneration of the intervertebral disc and the symptoms that arise from it. Disc degeneration is a natural process that, in many cases, does not present any symptoms. For example, by the age of 50, radiological findings of disc disease are expected in more than 50% of individuals.
Genetics play a significant role (similar to how skin aging affects the appearance of wrinkles), but environmental factors also contribute, such as heavy lifting, exposure to vibrations, smoking, etc. The intervertebral discs have a limited ability to heal from potential injuries due to the small number of cells inside the disc and the lack of blood vessels in the area (similar to the meniscus in the knee).
Symptoms
Pain is primarily localized in the lower back (low back pain – lumbago) and may radiate to the buttocks and the back of the thighs, reaching just above the knees but not extending to the foot. Symptoms worsen when sitting or standing/walking for extended periods and improve when lying down. Movement of the lower back (lumbar spine) is limited and painful.
The patient does not find relief by bending forward; in fact, this may worsen the pain due to the increased pressure inside the disc. During examination, sensation, mobility, and reflexes are usually normal.
MRI scans show disc degeneration, including a reduction in disc height and changes in its signal (the disc appears black instead of white, as shown in Figure 1). However, these findings are not exclusive to symptomatic individuals, as they are commonly seen in asymptomatic patients of all ages.
Conservative Treatment
Treatment is primarily conservative. In the acute phase, when pain is intense and interferes with daily activities, the following measures are recommended:
- Lumbar support belt (a standard lumbar support belt is sufficient).
- Heat therapy (some individuals may benefit from cold therapy, but heat packs are generally recommended).
- Medications: anti-inflammatory drugs, painkillers (simple and opioid-based), and medications for chronic pain (Gabapentin, Pregabalin, etc.). No injections!
- Physiotherapy (early application of physiotherapy can be very effective for severe pain).
Avoid
- Prolonged bed rest in the same position.
- Injections
- Extreme alternative treatments (e.g., hitting with a hammer, etc.). Acupuncture, for example, can be highly beneficial, whereas chiropractic treatment may sometimes be harmful. Chiropractic adjustments should only be performed with a thorough understanding of lumbar pathology (MRI scan required). While various treatments may have relative success, classic physiotherapy is the most effective.
In the chronic phase of disc disease, regular exercise is essential:
- Aerobic exercise such as walking, running, swimming, cycling, elliptical training, or any activity that increases heart rate, ideally 2-3 times per week.
- Strengthening the spine through abdominal and back muscle training is also crucial (Figure 2). Pilates has been found to be the most effective exercise, as it strengthens the core muscles isometrically (without excessive movement that stresses the spine) and incorporates leg stretches that significantly help with low back pain.
