Degenerative disc disease

A degenerative disease is a disease in which the function or structure of

the affected tissues or organs will progressively deteriorate over time, whether
due to normal bodily wear or lifestyle choices such as exercise or eating habits.
Degenerative diseases are often contrasted with infectious diseases. Because
degenerative disc disease is primarily associated with the aging process, it cannot
be prevented in all cases. Moderate exercise, lifestyle modifications, and good
nutrition can help prevent painful and disabling symptoms.
A constant reactivity and change in the form and probably functioning is
one of the important features of living beings in biosphere. As the age passes
(currently it can be taken above 40 years) the body tissues degenerates gradually.
In Ayurveda it is called as Kaalaja Jaraa (Natural Aging). This is physiological &
controlled by various systems the body. But if degeneration starts early it is
pathological & leads to many diseases such as osteoarthritis, cataract,
Degenerative disc disease, dementia, baldness, graying of hair, Hardening of
blood vessel, Alzheimer's Disease, Parkinson's Disease, Diabetes etc. this is called
as Akaalaja Jaraa (Premature aging).
Disc degeneration is a natural part of aging and over time all people will
exhibit changes in their discs consistent with a greater or lesser degree of
degeneration. However, not all people will develop symptoms. In fact,
degenerative disc disease is quite variable in its nature and severity.
Anatomy of the Spine:
the spine is made up of the following components:
1) Vertebrae - the bones that make up spine
2) Nerves - entire nerve system runs through spine
3) Discs - spongy material that separates vertebrae, allowing the nerves to run
between each bone segment. Discs act like shock absorbers and allow the spine to
flex.
Each vertebra is held in its proper place by three different kinds of soft tissue-
discs, ligaments, and muscles. Almost all back problems are related to the
dysfunction of one of these three.
Degenerative disc disease (DDD):
Degeneration of the intervertebral disc, which is often called "degenerative disc
disease" (DDD) of the spine, is a condition that can be painful and can greatly
affect the quality of one's life. While disc degeneration is a normal part of aging
and for most people is not a problem, for certain individuals a degenerated disc
can cause severe constant chronic pain. Spondylosis is another term for
degenerative disc disease.
DDD can affect any part of the spine, although common sites are the lumbar
(lower back) and cervical (neck) spine; thoracic DDD is very uncommon. People
in the 20?s and 30?s may already have changes to their discs but no clinical
symptoms. As the aging processes continues, the prevalence of DDD increases.
In the early phases of DDD, spontaneous or post-traumatic tears, degeneration,
fibrosis, and collapse of the disc may lead to failure of mechanical function. This
is associated with low back pain and possible leg pain if there is nerve root
compression (radiculopathy).
Low Back Pain:
Low back pain is common. The main cause for low back pain is a strain of the
muscles, or other soft structures (eg ligaments and tendons) connected to the
back bones (vertebrae). Sometimes it is the cushion between the bones
(intervertebral disc) which is strained, and which bulges out (herniates) and
presses on the nearby nerves (as in sciatica).
Low back pain is pain affecting the lower part of the back. It is described as:
 Acute if it has lasted less than 6 weeks.
 Sub-acute if it has lasted 6-12 weeks.
 Chronic if it has lasted more than 12 weeks.
Risk factors:
• Age
• Activity
• Smoking
• Obesity
• Vibration
• Sedentary work
• Psychological factors
Common causes:
Degenerative disc disease can result from trauma (either acute or
chronic/repetitive), infection, or the natural processes of aging.
Trauma micro or macro as a simple lifting accident is the most common cause of
disc degeneration.
Disease process:
After trauma the discs in the spine dehydrate, or dry out, and lose their
ability to act as shock absorbers between the vertebrae. There is minimal blood
supply to the discs so they lack the ability to heal or repair themselves.
Trauma → dehydration (reduction of water content) of Disc → loss of shock
absorbers action → narrowing of disc space → thickening of ligament→
osteophyte (bony growth) formation→ narrowing of spinal canal & compression
on nerve→ backache, sciatica, spinal cord diseases etc.
Slip Disc or Disc Prolapse or Prolapse of Intervertrebral Disc (PID):

Prolapse of disc beyond its normal confines is called a disc prolapse. It can occur
in any direction but is problematic when it occurs into the spinal canal or
neural foramen (region from which nerves come out of spine).
Causes:
Any situation which increases the pressure within a disc can lead to damage and
prolapse. Lifting heavy objects with the back bent is a common cause. Coughing
or sneezing may also cause a prolapse to occur. Less commonly, a fall or injury
damages the disc.
Disease process:
A sudden increase in pressure on the disc causes a tear in the tough outer ring. If
the tear extends right through the outer ring, some of the soft centre may
prolapse. As well as local pressure on the nerve from the disc, there is swelling
and inflammation. This inflammation is responsible in part for the severe pain
caused by a disc prolapse.
Symptoms of Degenetaive disc disease:
 Pain in the low back,
 Pain that worsens when sitting, bending, lifting, or twisting
 Pain that feels better when walking, changing positions, or lying down
 Periods of severe pain that gets better after a few days or months
Symptoms of Slip Disc:
The symptoms depend on the site, degree and direction of disc prolapse. It
commonly occurs in the lumbar or cervical (neck) region and can cause low back
ache or neck pain. If the prolapsed disc causes compression of a particular nerve
supplying the limb then there will be radiation of pain to that limb.

 Radiating Pain from low back or buttocks to thighs, legs & foot
 Pain worsens by long sitting, jerky movements, sneezing, coughing etc
 Numbness and tingling into the legs
 Weakness in the legs
 Foot drop (inability to raise the foot at the ankle)
Diagnosis:
Your doctor will ask about your symptoms and medical history, and perform a
physical examination. Other tests may include:
 Blood and/or urine tests to rule out other causes of pain
 MRI scan—a test that uses magnetic waves to make pictures of structures
inside the body
 X-ray—a test that uses radiation to take a picture of structures inside the
body, especially the bones
 Discography—dye is injected into the affected spinal area to get clearer x-
ray images
The United Kingdom has guidelines for doctors and other professionals on how
best to manage a person with back pain. These guidelines cover many aspects,
but there are some main principles which are most important.
 The first thing is to rule out any other obvious conditions which also cause
back pain.
 There are a number of "red flags", or warning signs, which are factors
which lead the doctor to arrange for more rapid investigation and
treatment than would otherwise be necessary. They may point to
something more serious going on than simple, or mechanical back pain. If
any of them applies to you, you should see your doctor soon:
o You are younger than 20 or older than 55 when you get back pain
for the first time.
o The pain follows a violent injury, such as a road traffic accident.
o The pain is constant and getting worse.
o The pain is in the upper part of the spine.
o You have had cancer in the past or at present.
o You are on steroids.
o You are a drug abuser, or have HIV.
o You are generally unwell in yourself.
o You have lost significant weight.
o You continue to have great difficulty bending forwards.
o You have developed a number of problems in your nervous system
(eg numbness, loss of power, etc).
o You have developed an obvious structural deformity of your spine.
 You should also see your doctor (either for a first visit, or for a follow-up)
if the pain is continuing for more than 4-6 weeks.
Ayurvedic Management:
Advantages of Ayurvedic Management over modern management
Arrests the process of degeneration & helps in regeneration of soft tissue
damages.
Prevention of disc prolapse or disc rupture.
Ayurvedic drugs do not produce hyperacidity, stomach or duodenal ulcer etc
Some important Guidelines:
 The main thing about most low back pain is do not worry - it will usually
get better on its own, within a few days, or possibly a few weeks.
 Stay active, and if at all possible, stay at work.
 The pain may force you to rest, but this is a result of the pain, and not a
good treatment for back pain. If you have to take to your bed, limit it, if
possible, to a day or two at the most.
  If it seems to be lasting more than a few days, consider seeing a specilist.
 If you do have to be off work, keep this to a minimum, and do not expect
to be pain free before you go back.

Commonly used medicinal plants used –

Rasna (Pluchea lanciolata), Guduchi (Tinospora Cordifolia), Gokshura (trebulus
terrestris), Ashvagandha (Withania Somnifera), Eranda (ricinus communis),
Shunthi (Zingiber officinalis), Lakshaa, Balaa (sida cordifolia), Guggulu
(Commiphora mukul), Shatavri (Asparagus recemosus), Nirundi (vitex
Negundo), Pippalimula (piper longum) etc.

Simple home remedies:

A] Internal:
 Juice of Guduchi 20ml with 1 tsf Cow’s ghee
 Decoction of Guduchi, Rasna, Gokshura, Amalaki, Nirgundi (all in equal
quantity). Take luke warm decoction 30 ml with 10 ml of ghee.
 Combination of powders of Ashvagandha, Shatavari, Yashtimadhu,
Gokshura, Pippalimula, Chopachini (smilax china) all in equal quantity.
 Add 5 gm Ashvagandha powder to 40ml milk & 160ml water. Boil on mild
fire till only milk remains. Then take warm milk by adding sugar if
necessary.
 Powders of Guduchi, gokshura, Aamalaki in equal quantity with milk &
sugar.
 Paste of 5-10 pearls of Garlic fried in Tila taila (gingili oil)
 Take Castor oil (refined) 5-10 ml with 20ml decoction of Shunthi on empty
stomach at morning.
B] External:
 Application of warm paste of Nirgundi, Dattura (Datura Metal) Shigru
(Moringa oleifera)& Rock salt over the affected area & then cover with a
cloth.
 Massage from the oil prepared by mixing Eucalyptus oil, oil of
wintergreen, Camphor together.

Simple Ayurvedic formulations-

Internal-
Mahayogaraj Guggulu 2 tab. thrice a day with 1 tsf Ghee & warm water.
Trayodashanga Guggulu 2 tab. thrice a day with 1 tsf Ghee & warm water.
Asvagandhadi churna 6gm twice with warm milk.
Ksheerabala taila 101, 5-10 drops with warm milk.
Dashamularishtha 20ml twice a day with equal water after meal.
Eranda Paka 6-10gm with warm milk
Rasnadi Kashaya 20 ml twice with warm water.
External-
Ksheerabala taila, panchaguna taila, Dhanvantaram taila etc are useful.
Prevention of Degenerative Disc Disease:
Regular oil massage of whole body especially those who are above 40 years of
age.
A course of Matra Basti twice a year
Phyzichil once in year.
Regular practice of Yogasana, Pranayama & exercise
Modifying the life style
Pathya (Do’s):
Food-
Black gram, Horse gram, wheat, rice, gingili oil, mustard oil, ghee, milk , butter,
sour fruits, Dry grapes, garlic, drumstick fruits & leaves, meat,
Activities:
Pouring of warm water, residing at non windy place, gentle squeezing,
tub bath, oil massage, application of hot & oily substances, covering the body
with blankets.
Apathya (Don’ts):
Food-
Potato, Cucumber, cold drinks, ice cream, Rajma, dry meat, etc
Activities-
Bending, sudden stretching, weight lifting, long journey on two wheeler, sitting
in abnormal posture, sitting for long time.
Advice:
• Keep a wide base in standing
• Keep body weight in equal distribution
• Toes must be able to function freely
• Hip must be placed right into back of the seat
• Bedding must be firm & soft
• Thin pillow
• Chair having armrest should be used
• Try to avoid constipation, cough, cold, flatulence (gas) as they worsen the
condition.
• Strengthen back and abdomen muscles that support your spine with
swimming, walking, or exercises recommended by a physical therapist.
• Use good posture to relieve pressure on your lower back.
• Avoid sitting for long periods.
• Consider occupational therapy or job retraining if your work requires lots of heavy
lifting or prolonged sitting (such as long-distance trucking).