Degenerative Disc Disease (DDD) - Treatment and Condition

Question 1

What is DDD?

Answer 1

Degeneration of the annular fibers of the intervertebral disc.

Question 2

What are other terms used in reference of DDD?

Answer 2

Spondylosis - Degenerative changes in the facet joint.
Slipped Disc - Lay term for Disc herniation.
Lumbago - General, non-specific term for low back pain.
Sciatica - …

Question 3

What are causes for DDD?

Answer 3

Chronic overloading of the disc leading to annular fiber microtearing and migration of nucleus.

Question 4

What are contributing factors that lead to DDD?

Answer 4

Trauma, Mm imbalance, Postural Dysfunction, Poor blood supply to disc.

Question 5

What are the Stages of DDD?

Answer 5

Dysfunction stage, Instability stage, Stabilization stage.

Question 6

What is the Dysfunction stage of DDD?

Answer 6

Biomachanical changes over time result in weakness, bulging and minor tears in the annulus fibers, which heal slowly.
May be symptomatic, may be painful chronic facet joint irritation, joint effusion and mm spasms.

Question 7

What is the Instability Stage of DDD?

Answer 7

Posterior annular fibers and joint capsule become weak causing them to become hypermobile.
Tissue changes in this stage are considered permanent.

Question 8

What is the Stabilization Stage of DDD?

Answer 8

Loss of disc material and decreased disc hight, intervertebral foramen narrows, the joint capsules and post ligamentous fibers.

Stenosis may occur and degeneration may spread to other vertebral levels.

Question 9

What stage of DDD is considered to be reversable?

Answer 9

The first stage (Dysfunction Stage).

Question 10

What does the symptom picture for Acute Disc herniation look like?

Answer 10

Acute disc herniation can occur at any stage, but most commonly at the end of Dysfunction or the start of Instability.

Question 11

Were does pain arise from in an acute disc herniation?

Answer 11

Pain arises from compression of pain sensitive structures by the protrusion.

Question 12

When pain arises from compression of pain sensitive structures near a disc herniation, what are these structures?

Answer 12

This could include:
Nn roots, ligaments, dura matter, and Bv’s.
Pain is usually worse in the morning because the nucleus is still contained in the annulus fibers.

Question 13

With Disc herniation, when does pain increase?

Answer 13

Pain mostly increases when a person is inactive.

Question 14

What does AF and PR Rom testing reveal in a client with DDD?

Answer 14

AF PR Rom of ether C-spine or lumbar may reveal reduced ranges, with PR rom having more available range.

Question 15

What is the most restricted range in a client with DDD?

Answer 15

Spine extension is the most restricted, stiffness is likely, pain may or may not be present.

Question 16

What is involved in testing Acute Disc herniation?

Answer 16

In the lumbar spine, AF Flexion may have a deviation to one side.

Question 17

What special test can be used for clients with Acute Disc herniations?

Answer 17

With Cervical Disc herniations:
ULTT’s, Spurling’s, Valsalvas.

Lumbar Herniations:
Slumps, Valalvas, Kemps, Kernigs, Straight leg raise.

Question 18

What does a General Treatment for DDD of the Cervical Spine involve?

Answer 18

Heat to Affected areas / Fascial restrictions.
If client has anterior head posture, begin on the:
Chest, scalenes and intercostals, on shortened posterior cervical Mm’s use deeper work and passive stretching.

Question 19

What does a general treatment of a client with DDD in lumbar spine?

Answer 19

If client has hyperlordosis begin with treating the Hip flexors, lumbar erectors, glutes, QL and Quads.

Question 20

What does treatment of an Acute herniation involve?

Answer 20

If the client is in spasm, Use ice to reduce pain and Spasm.
If the herniation is in the posterior direction:
When the client is supine the legs are extended with no pillow under the knees.
In the Prone position, Lumbar spine is extended with no pillow under abdomen.

Question 21

What is the goal of treatment for a Client with Acute Disc herniation?

Answer 21

The main goal is to reduce Edema, Spasm and pain in mm’s that cross the affected area.
MLD, Eff, GSM gentle fascia and TP release is can be used.