Degenerative disc disease explained: causes, tests and treatment options

Short answer: degenerative disc disease, or discopathy, is the slow breakdown of the cushions between your vertebrae. It usually builds over decades, from years of sitting, sleep posture, phones and old injuries, before it causes symptoms like back or neck pain, stiffness, trouble standing up, or sciatica and numbness when a disc presses on a nerve. Most back pain improves with conservative care, and surgery is rarely the first step.

Dr. Mohamed Karim, D.C., whose North Liberty clinic treats disc problems, spoke with Dr. Andrew Harris, a chiropractor with 26 years in practice and an electrical engineering background, who runs Florida Spine and Disc Institute in Ormond Beach, Florida.

What a disc does, and how it breaks down

Each disc is a pad between two vertebrae that lets your spine bend and twist. Dr. Harris describes it as mostly fluid with a cartilage shell. Over years of load it dries out and loses height, and it can bulge or herniate, pressing on nearby nerves.

He compares it to teeth. We brush daily and see a dentist yearly because damage builds quietly. A disc can be breaking down for 10 or 20 years before it ever hurts.

Common causes

• Sitting for hours. He estimates sitting adds roughly four times the load on the low back.
• Sleeping on your stomach, which he calls the single worst position for the spine.
• “Tech neck” from looking down at phones, now showing up in people in their 20s.
• Falls, sports injuries and car accidents.
• Extra body weight, which does not cause disc breakdown but makes healing harder.

Signs to take seriously

• Back or neck pain that keeps coming back
• Difficulty going from sitting to standing, or lying to sitting
• Pain, numbness or tingling traveling into an arm or leg
• Reduced range of motion

Get emergency care for back pain with loss of bladder or bowel control, numbness in the groin or inner thighs, or rapidly worsening leg weakness. Those can signal a nerve emergency.

X-ray or MRI?

An X-ray shows bone, not the disc itself, but a disc that has lost height shows as vertebrae sitting closer together. An MRI shows the disc directly, including the type and location of a herniation. Dr. Harris starts with an X-ray and orders an MRI when disc height looks significantly reduced.

Treatment options

Dr. Harris’s practice centers on non-surgical spinal decompression: a motorized table that gently stretches the spine to take pressure off a disc. He explains it like a balloon: press down and it bulges out; release the pressure and it can move back. He combines it with adjustments, electrical stimulation, and, when progress stalls, shockwave or laser. Between visits he asks patients to ice in 20-minutes-on, 20-minutes-off cycles.

How the evidence looks:

• The American College of Physicians notes that most new low back pain improves over time whatever the treatment, and recommends heat, massage, acupuncture or spinal manipulation first.
• For chronic low back pain it recommends starting with exercise, rehabilitation, yoga, tai chi, acupuncture or spinal manipulation. Dr. Harris is skeptical of physical therapy for disc problems, but exercise-based care is a guideline-recommended first step.
• Research on traction-style decompression is limited and mixed. If you try it, ask how the clinic will measure your progress and when it would change course.

PRP and stem cells

Both doctors agree on timing: regenerative injections only make sense when there is living, functional tissue to work with. Dr. Karim’s clinic offers PRP and stem cells and uses them only after several months of rehab, when the area is moving again. Keep in mind that the FDA has not approved stem cell products for disc or back pain.

When surgery is needed

In severe cases with major disc destruction or nerve damage, surgery can be the right call. Dr. Harris warns that recovery after a fusion often takes about a year, and that fused segments shift extra load onto the discs above and below, which can wear faster. Talk those trade-offs through with a spine surgeon.

Keeping your discs healthy

• Move for at least 30 minutes a day, even just walking and stretching.
• Sit upright, with screens at eye level.
• Back sleepers: pillow under the knees. Side sleepers: pillow between the knees. Avoid stomach sleeping.
• Try yoga or swimming to keep the spine mobile.
• Do not wait until pain arrives. Pain is often the last step, not the first.

Watch the full interview

Back pain that will not settle? Book a free consultation in North Liberty. Related: shockwave therapy and why weight loss gets harder with age.

This article summarizes a podcast interview and is general information, not medical advice. Guidelines: American College of Physicians, Noninvasive Treatments for Low Back Pain. See our medical disclaimer.