Degenerative joint disease

Degenerative joint disease (DDD) is a common condition among the general population representing the natural aging of the spine. In the lumbar spine degenerative joint disease has several other names such as lumbar spondylosis, arthritis or more commonly just simple wear ‘n tear. Lumbar spondylosis can begin in persons as young as 20 years and increases with age. Degenerative spine changes are remarkably common with the prevalence of spondylotic changes in the lower back increases from 37% among 20-year-old to 96% of 80-year-olds. Interestingly, these individuals were asymptomatic.

DDD generally initiates from the intervertebral disc. The annulus fibrosis loses water content over time. This has very direct effects on the ability of the spine to absorb shock and impact and makes it increasingly vulnerable to the daily stresses and strains placed on the spine. The loss of compliance in the discs contributes to forces being transferring pressure to the facet joints. This can lead to increased pressure on joint surfaces, capsule irritation or aggravation of the small sensory nerves which supply the soft tissues of the facet joints. However, over time this increased pressure can result in changes to the structure of the spine including abnormal growth of the vertebral body and the development of bony overgrowths known as bony spurs or osteophytes making them stiff to move and blocking movement in certain directions

Symptoms of DDD, if experienced, vary widely and often there is no specific type of pain just a general stiffness and discomfort across the lower spine.

Activities that typically increase pain include:

• Sitting for extended periods of time
• Rotating, bending, or lifting

Activities that typically decrease pain include: 

• Frequent changes in positions
• Lying down
• Staying active

Management of DDD includes a combination of manual therapy and physical exercises. Lumbar mobilizations are common manual therapy techniques used to decrease low back pain (LBP) and increase lumbar spine range of motion. During mobilization, the clinician's hands produce oscillatory movements of a specific grade to a single vertebra of the lumbar spine and induces several physiological responses including pain reduction, improved joint mobility, hypoalgesia, and change in muscle activity/contraction by activating receptors in the joints and muscles and the brains natural opioid releasing circuitry. Strength training aims to enhance core stability by strengthening and improving the coordination between the abdominal and back muscles to increase our capacity to resist higher loads in the degenerative discs. Exercises are performed to reduce pain and to ensure stability by strengthening the hip extensors, hip flexors, abdominal muscles and the sacrospinalis muscles