Degenerative Disc Disease
Degenerative disc disease is one of the most common causes of low back pain, and also one of the most misunderstood.
When talking about these changes, your doctor may use the terms degeneration or degenerative disc disease. Although the parts of the spine do change with time and in some sense degenerate, this does not mean the spine is deteriorating and that you are headed for future pain and problems. These terms are simply a starting point for describing what occurs in the spine over time, and how the changes may explain the symptoms people feel.
An intervertebral disc sits between each pair of vertebrae (spine bone). A disc works like a shock absorber and a spacer between vertebrae. The center of the disc is called the nucleus. The nucleus is a thick jelly like material that provides most of the disc's ability to act like as shock absorber. 
The nucleus is held in place by the annulus, a series of strong ligament rings surrounding the jelly like nucleus. The annulus attaches to the vertebrae above and below each disc.
Intervertebral discs change with age, the nucleus dehydrates and shrinks in size (degenerative disc) decreasing the space between vertebrae.
"Bone spurs" (Osteophytes)
"Bone spurs" (Osteophytes) another type of spinal degeneration is really a misnomer, as the word "spurs" give the impression of a bony growth spurring or poking soft tissue. “Bone spurs” are generally smoother structures that develop over a long time. Bone spurs large are in general a normal finding as we age, therefore they are actually quite common over the age of 45.
Daily wear and tear causes everyone's spine and discs to degenerate. The rate of disc and boney degeneration can increase as the results of; major back injury, spinal fracture, certain types of vibration (example operating equipment that causes vibration), heavy or highly repetitive lifting (especially if lifting is done incorrectly). There is evidence that smoking speeds up degeneration of the spine. Genetic links among family members show that genetics play a role in how fast these changes occur.
Spinal degeneration (disc or bone) is not always painful. Many people who have DDD and bone spurs on X-ray report no history of lower back pain. Pain caused by degenerative disc disease is mainly mechanical pain, meaning it comes from the parts of the spine that move during activity: the discs, ligaments, and facet joints. In the case of DDD (degenerative disc disease) pain comes when the shrinking space between vertebrae causes pressure on tissue that don't normally have pressure between them. This can be amplified by the presence of bone spurs that may press on soft tissues. DDD can first be seen when a person is in their twenties or thirties. Central back pain and/or stiffness are often the first sign of DDD. Heavy physical activity, a bad fall, motor vehicle accident, repetitive lifting, or staying in one posture for a long time (especially in flexed position) can flare the pain/stiffness up. Early on the back pain may only last one to three days depending on cause of onset. Over years the pain and stiffness of the lower back may come and go. The pain may vary from episode to episode, but it generally gets worse over the years and may be accompanied by intermittent pain going into the buttock or down one or both lower extremities.
Center for Spinal Excellence Non-surgical Rehabilitation
Whenever possible, nonsurgical treatment of lumbar degenerative disc disease is preferred. The first goal of nonsurgical treatment is to ease pain and other symptoms so the patient can resume normal activities as soon as possible. We rarely prescribe bed rest for patients with degenerative disc problems. Instead, patients are encouraged to do their normal activities using pain as a gauge for how much is too much. If symptoms are severe, a maximum of typically two days of bed rest may be prescribed. After evaluating your condition, your Physical Therapist at a Center for Spinal Excellence can assign positions and exercises to ease symptoms. Our Physical Therapist can design a personalized exercise program to improve flexibility of tight muscles, to strengthen the back and abdominal muscles, and to help you move safely and with less pain. Although recovery time varies among patients, as a guideline you may expect to work with our Physical Therapist a few times each week for four to six weeks. In some cases, patients may need a few additional weeks of care. Our first goal of treatment is to control symptoms. Your Physical Therapist will work with you to find positions and movements that ease pain. Our Physical Therapist may perform hands-on treatments such as massage and specialized forms of soft-tissue mobilization as well as gentle spinal mobilization. These can help a patient begin moving with less pain and greater ease. Spinal decompression is also a common treatment for degenerative disc problems at Center for Spinal Excellence. Spinal decompression gently stretches the spine increasing the uptake of oxygen, nutrients, fluid and disc materials into the disc space. Our Physical Therapist will instruct you on stretches that will help you move easier and with less pain. As you recover, we will gradually advance you in a series of strengthening exercises for the abdominal and low back muscles. Working these core muscles helps patients move more easily and lessens the chances of future pain and problems. A primary purpose of Physical Therapy is to help you learn how to take care of your symptoms and prevent future problems. We'll give you a home program of exercises to continue improve flexibility, posture, endurance, and low back and abdominal strength. Our Physical Therapist will also discuss activities and postures that you need to avoid to decrease stress on your spine.
Post-surgical RehabilitationRehabilitation after surgery is more complex. Some patients leave the hospital shortly after surgery. However, some surgeries require patients to stay in the hospital for a few days. During recovery from surgery, patients should follow their surgeon's instructions about wearing a back brace or support belt. You should be cautious about overdoing activities in the first few weeks after surgery. Many surgical patients need Physical Therapy outside of the hospital. Patients who've had lumbar fusion surgery normally need to wait up to three months before beginning a rehabilitation program. Our treatment sessions help patients build strength and learn to move and do routine activities without putting extra strain on their backs. Although the length of rehabilitation programs vary based on an individual patient's rate of recovery, as a guideline you can expect to attend Physical Therapy sessions for eight to 12 weeks and should expect full recovery to take up to six months. As your Physical Therapy sessions come to an end, our Physical Therapist will help you get back to the activities you enjoy. You may need guidance on which activities are safe or how to change the way you go about your activities. Ideally, patients are able to resume normal activities.
