Posted by Chris on January 01, 1999 at 20:25:15:
I found this in the Newsgroup alt.support.chronic-pain
Degenerative Disc-The End of the Road?
By Dr. Tim Maggs
More than once, a runner has come up to me with that dejected and lost look on his or her face, and proceeded to tell me, "I've been diagnosed with a degenerative disc by my doctor. Looks like my running days are over."
I generally pause before I reply, so they can give all the details of their "unique and grave" story. And typically, these conversations don't take place in the confines of my office. They're usually in some shoe store in a mall or the starting line of a race two minutes before the gun goes off.
Once they've finished their Shakespearean tragedy, I begin my reporterlike interrogation. "Why would you think your running days are over? Did you run out of your doctor's office before they told you what to do?"
"Why, no," they usually respond. "My doctor's the one who told me my running days were over. As I understood it, there's nothing you can do once a disc is degenerated." "Did you ask why the disc is degenerated?" I asked.
"He said it's real common. In fact, he said he has one, too."
"And what did he recommend for it?"
"Nothing, other than to quit running".
(Now, even though all my questions are purely leading questions and I could pretty much guess the answers, I do have an ultimate objective, which is beneficial for the patient/ "former" runner. I know the answers given by the typical doctor would put all of us on our backside watching TV for a living. But, as I tell many
patients, "As long as you keep moving, they can't throw dirt on you. Motion breeds momentum and momentum is the high of life we're all looking for.")
Cause of Degeneration
There are always hereditary causes when talking about any health condition, but let's not take the easy way out. Let's talk about some causes we can affect. First of all, joints of the spine should have full motion so that the discs, which are soft tissue pads between the vertebrae (bones), can receive fresh blood (oxygen and
nutrition). Motion brings the majority of blood to the discs after the age of 25. When motion is lost, which happens when a joint of the spine "locks up", the blood flow is diminished and disc degeneration begins.
Motion is lost due to a host of causes-injury to the back, poor postural habits, imbalances in the spine from a short leg, running on the slanted side of a road, poor sleeping surfaces, weight and so forth. Sometimes there is pain associated with the initial onset, and sometimes there isn't.
As time goes on, if motion isn't restored to the joint, muscles surrounding and supporting the joint begin to shorten and harden, losing flexibility. The space for the nerves to exit behind the vertebrae begins to decrease, compromising the nerve output. And low and behold, the disc begins to wear down, because of lack of food
and oxygen and because weight is now absorbed very inefficiently and not evenly dispersed as it would be with full motion in the joint.
Most people will never address a problem until it becomes a crisis. In the case of a condition such as this, the crisis can sometimes take 10 years from the moment of onset. Intermittent back problems can occur during that time, but the "big one" can sometimes take that long.
The only way to address and solve this condition is with a logical and progressive approach. There is no "magic bullet." The only correction is one step at a time. There are generally three phases of correction, and if you try to skip one of them, you'll usually end right back where you started.
1.) The Fire
During the acute phase, the joint and surrounding tissues become highly inflamed and spastic. This is painful. The first and only objective at this point is to put out the fire. This should be done as quickly as possible (it sometimes takes two to six weeks) because this stage is the most costly, painful and debilitating. Rest, ice,
physical therapy, chiropractic and/or anti-inflammatories are a must. A back support should also be used if needed. NO exercise during this period will get you through this phase much quicker. That's not saying you can't do it, but the cost and time frame will both increase if you don't show some serious discipline during this stage.
This is the stage that most people never hear about. Motion must be restored to the involved joint and a re-conditioning of the supportive muscles has to be considered to ever improve the overall well-being of the back. Most low-back pain sufferers like to think that when the pain is gone, the problem's gone. Rid that
thought from your mind. This is the beginning of your corrective phase. This stage truly takes four to six months of dedicated work, but will pay huge dividends if you can see it through. This stage is the one that will make all the difference and the value of it should never be questioned.
A combination of spinal exercises, habit improvement, chiropractic manipulation, weight management, ice/heat treatments and nutritional supplementation are all a part of this stage. A good coach is beneficial but not a must. If you don't have a good doctor or coach guiding you through this stage, you must create the strategy and motivation to see your way completely through, because a partial effort usually leaves you short of your goal. Once the initial exercises are introduced and
prove to be safe and effective (usually about seven to 10 days into it), aerobic exercise, such as running, aerobics, cycling, weight lifting, etc., can be introduced. Start slowly and add in small increments. If and when any symptoms come on, you're going too quickly and must back off for a couple of days. Never ignore what your back is telling you.
This phase is the rest of your life. What is the least amount of effort, time and money that you have to spend to maintain the excellent changes made in the past nine months? If you stop all efforts, obviously, you will migrate right back to square one. Age works against all of us, so the effort may need to increase every year. But remember, the benefits of being able to stay active vs. disability have no price. The details of what is needed in this category are just a modified version of what
you've done in the rehab phase. It is truly a trial-and-error approach for everyone.
Remember, the only thing that stays the same is that everything is always changing. If setbacks occur, always go back to the basics. Shortcuts usually prove to be worthless and discipline is always your greatest ally. And don't become psychotic. Don't let your physical ailment become mental, too. With all back problems, you will pay with pain, suffering, disability and a lot of money, or with hard work, discipline and minimal money. Effort and persistence equal happiness and the ability to
exercise. Don't accept bleak prognoses from those who have no answers. For anyone willing to do the work, greener pastures lie ahead. Good luck!
For further information, contact Dr. Maggs at (800) 987-7845 or at RunningDr@ aol.com or at http://www.teamstick.com
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