Degenerative Disc Disease (DDD) vs Degenerative Joint Disease (DJD)
Have you been given one of these diagnoses DDD or DJD? Depending
on how specific your healthcare practitioner is, you may have heard these terms
before as the source of your spine pain. Degenerative disc disease or DDD
can be the cause of many different symptoms resulting in localized pain or pain
that radiates down the leg. Degenerative joint disease or DJD is
very different, but can have overlapping symptoms with DDD. We will
discuss both of these conditions a little more thoroughly so if you are faced
with these terms, you can understand the difference and seek the appropriate
care.
Degenerative Disc Disease
To understand some of the symptoms that may arise with DDD, let us first
consider the anatomical structures that are involved.
Degeneration first occurs after there are small tears within the outer fibres
of the disc. Over time, this changes the distribution of forces over the
disc material and the vertebrae starts to grow small bone spurs to aid in the
stability of this particular bony segment of the spine. More tears may or
may not occur within the outer disc fibres progressing the degeneration
process. As we age, the fluid content of the disc material begins to
decrease affecting the height of the disc. As the height decreases, the
disc material will begin to push outwards. Disc material in combination
with bone spurs can add extra pressure to the nerve root which is exiting the
spine at the degenerative level. Very small increases in pressure on the
nerve, can cause significant levels of pain.
This is a condition that takes many years to develop. Initially, one may
experience an episode of acute low back pain. Pain can be localized to
the back or you may have referred pain down into the buttock or leg. In
most cases, this patient will recover fairly quickly and will return to normal
activities. This particular patient may experience one or several more
episodes throughout their life. After the age of 50, this patient may
experience a more prolonged period of low back pain, or low back pain that
doesn't completely go away. The symptoms tend to be very similar to a
disc bulge, moderate to severe leg pain with or without low back pain.
Chiropractic treatment is going to initially focus on pain control by
decreasing inflammation. Once the pain is manageable, treatment will
involve more introduction of movement through some form of spinal manipulation,
exercise and muscle treatments (ART, Graston, massage,etc...). In
addition, education will provide self treatment options, proper ergononmics and
exercise technique. An important concept to remember with DDD is that
treatment does not reverse any of the anatomic changes that occur, but helps
manage the symptoms.
Degenerative Joint Disease
With this condition, there is a similar process that is occuring, but at a
different location on the vertebrae. The anatomical structure involved in
DJD is the facet joint. There are 2 facet joints at each level in the
spine that allow the vertebrae to move within 6 different ranges of
motion. The facet joints are synovial joints filled with synovial fluid
and surrounded by ligamentous tissue. When there is an increase in
pressure on the facet joints by postural changes that cause the weight of the
spine to be forced posterior off of the discs, as is seen in an increased
lumbar curvature or hyperlordosis, bone will start to grow bone spurs as a
means to increase stability and help distribute the weight.
Bone spurs can push on the nerve roots which travel directly below the joint
causing some nerve irritation or pressure. Now we may have some referred
pain that accompanies spine pain.
Treatment for DJD is going to be very similar to DDD however, here, the first
thing we want to do is work on increasing motion at the joint in combination
with decreasing inflammation. Part of the pain source has to do with the
joint being restricted in motion, so this is why increasing mobility will be the
main form of pain relief. Then the focus will be on corrective exercise
to help change the weight distribution back to the disc to remove the pressure
on the joints. Again, treatment isn't going to reverese the bony changes
that have already occured, but treatment can prolong the mobility of the joint
and slow the progression of degeneration.
In : Spinal Degeneration