For most people, degenerative disc disease can be successfully treated with conservative (meaning non-surgical) care consisting of medication to control inflammation and pain (steroid medications delivered either orally or through an epidural injections), and physical therapy and exercise.
Surgery is only considered when patients have not achieved relief over six months of nonsurgical care and/or are significantly constrained in performing everyday activities.
The ongoing pain, as well as the frequency and intensity of the flares, can be mitigated through a number of non-surgical options.
The first line of treatment is usually to avoid aggravating the condition. Modifying activities to preclude lifting of heavy objects and playing sports that require rotating the back (e.g. golf, basketball, or football) can be a good first step.
In addition, it is also helpful to learn correct ergonomics, such as how to lift heavy objects, how to set up the office chair and workspace, and sleep postures that reduce pressure on the low back.
Common Nonsurgical Treatment
In addition, common nonsurgical treatment options usually include some combination of the following:
- Hamstring stretching, since tightness in the hamstring muscles down the back of the thigh can increase the stress on the back and make the pain caused by a lumbar degenerative disc worse
- A back strengthening exercise program, such as Dynamic Lumbar Stabilization exercises, where patients are taught to find their 'natural spine,' the position in which they feel most comfortable, and to maintain that position
- Low-impact aerobic conditioning (such as walking, swimming, biking) to ensure adequate flow of nutrients and blood to spine structures, and relieve pressure on the discs.
- Non-steroidal anti-inflammatories (e.g., ibuprofen, naproxen, COX-2 inhibitors) and pain relievers like acetaminophen (e.g. Tylenol) help many patients feel good enough to engage in regular activities.
- Stronger prescription medications, such as oral steroids, muscle relaxants, or narcotic pain medications may also be used to manage intense pain episodes on a short-term basis, and some patients may benefit from an epidural steroid injection.
Exercise and Physical Therapy
An exercise program is essential to relieving the pain of lumbar degenerative disc disease and is part of almost every treatment program for lumbar DDD. In general, an exercise program should have several components, including:
While it is common for patients to want to rest when the pain flares up, it is usually not advisable to rest for more than a day or two.
Heat and Ice
Applying heat to stiff muscles or joints to increase flexibility and range of motion, or using ice packs to cool down sore muscles or numb the area where painful flares are concentrated.
A range of medications often play a role in a comprehensive treatment plan.
Not all medications are right for all patients, and patients will need to discuss side effects, and possible factors that would preclude taking them, with their physician.
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Spinal manipulation, such as chiropractic manipulation, can relieve low back pain through several means, including taking pressure off sensitive nerves or tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and - as with more active exercise - promoting the release of endorphins within the body to act as natural painkillers.
Epidural Steroid Injections
An injection can provide low back pain relief by delivering medication directly to the painful area in the spine to decrease inflammation.
For the vast majority of people with symptomatic lumbar degenerative disc disease, a combination of nonsurgical treatments suffices to provide enough pain relief and ability to enjoy everyday activities. For a few with the most severe symptoms, however, surgery may be an option to consider.