Degenerative disc disease: what it means and how it's treated without surgery

What is degenerative disc disease?

The discs between the bones of your spine have a tough outer ring and a soft, water-rich centre. Over time, discs naturally:

• lose water (your MRI report may call this disc desiccation)
• lose height, so the space between the vertebrae narrows
• develop small tears in the outer ring

These changes are called disc degeneration. When they're thought to be causing pain, doctors and physiotherapists often call it degenerative disc disease. It's most common in the lower back and the neck.

Degenerative disc changes often happen alongside other age-related changes in the spine, such as lumbar spondylosis, a disc bulge or narrowing of the spinal canal (spinal stenosis).

How common is it?

Very common, and mostly harmless. A large 2015 review of scans in people with no back pain found disc degeneration in about 37% of 20-year-olds, rising to about 96% of 80-year-olds. The authors concluded that many of these changes are part of normal ageing.

However, in adults aged 50 or under, a second review found disc degeneration was more common in people with back pain than in people without. So disc changes can contribute to pain, especially in younger adults, but a scan finding alone doesn't prove it's the cause.

Symptoms

Degenerative disc changes often cause no symptoms. When they do, you may notice:

• a long-lasting ache in your lower back (or neck), sometimes with flare-ups
• pain that's worse after sitting for a long time, bending or lifting
• stiffness, especially in the morning or after rest
• pain that eases when you move around or change position
• if a nerve is irritated: pain, numbness or tingling spreading into a leg (or arm)

What causes it?

• Age. Discs gradually lose water and height over the years.
• Load. Heavy physical work, repeated bending and long hours of sitting may speed up changes.
• Other factors, such as genetics, smoking, excess body weight and previous injury, may play a part.

When back pain is an emergency

How it's diagnosed

At your Maana Spine assessment, your physiotherapist takes a detailed history, checks how your spine moves, tests the nerves in your legs or arms, and reviews any MRI, X-ray or lab reports you bring. Because disc degeneration is so common on scans, the aim is to work out whether it's really behind your pain, and what else may be contributing, such as muscle weakness, stiff joints or how you sit and move.

You'll get a physiotherapy diagnosis and a personalised plan. You don't need a scan to book; if one would help, your physiotherapist will recommend an MRI or X-ray.

→ What happens at your spine assessment

What the research says

Exercise. A 2021 Cochrane review found moderate-certainty evidence that exercise probably reduces pain in long-lasting low back pain, by an amount that makes a real difference to patients. Exercise is the foundation of every DTX program.

Spinal decompression. Results are mixed outside disc herniation with leg pain, and we'd rather you know that:

• A 2009 sham-controlled trial in people with long-lasting back pain from disc degeneration or a bulging disc, without leg pain, found both groups improved, with no significant difference between real and sham decompression.
• A 2019 double-blind trial in people with lumbar disc disease found pain improved in both groups, while day-to-day function and space in the spinal canal improved more with traction designed to keep the spine's natural curve.
• A 2010 study found that restored disc height after a six-week decompression course was linked to less low back pain. It had no comparison group, and it was sponsored by a company acting for the maker of the device studied.
• Overall, in the small trials so far, pain relief has been similar between decompression and traditional traction, and either works better combined with structured physiotherapy than physiotherapy alone.

PST (pulsed signal therapy). PST is a type of pulsed electromagnetic field (PEMF) therapy. A 2022 review of PEMF found it reduced long-lasting low back pain more than placebo or other treatments alone, though it didn't improve physical function. Another review suggested it helped most when added to other physiotherapy treatments. These studies used a range of PEMF devices, not necessarily PST.

→ Read our full review of the decompression evidence

Will I need surgery?

Most people with degenerative disc changes don't need surgery. Non-surgical care is a reasonable first step for most people, and surgery stays available if you need it. If your assessment suggests you should see a surgeon, we'll tell you honestly.

→ Do I need surgery for a disc problem?

Living with degenerative disc disease: practical tips

• Keep active. Regular walking and the exercises from your programme help more than rest.
• Change position often. Avoid sitting or standing in one position for long stretches.
• Build strength gradually. Stronger supporting muscles can help your back cope with daily loads.
• Expect ups and downs. Flare-ups are common and usually settle. A flare-up doesn't mean your spine is getting worse.

These are general tips, not a substitute for an assessment.

When to book a spine assessment

Book an assessment if your back or neck pain keeps coming back, has lasted more than a few weeks, spreads into your leg or arm, or stops you doing what you need to. Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. The consultation fee is ₹250, and no doctor's referral is needed.

Book a Spine Assessment · or call or WhatsApp +91 99950 09403