Have you been given one of these diagnoses DDD or DJD? Depending on how specific your healthcare practitioner is, you may have heard these terms before as the source of your spine pain. Degenerative disc disease or DDD can be the cause of many different symptoms resulting in localized pain or pain that radiates down the leg. Degenerative joint disease or DJD is very different, but can have overlapping symptoms with DDD. We will discuss both of these conditions a little more thoroughly so if you are faced with these terms, you can understand the difference and seek the appropriate care.
Degenerative Disc Disease
To understand some of the symptoms that may arise with DDD, let us first consider the anatomical structures that are involved.
Degeneration first occurs after there are small tears within the outer fibres of the disc. Over time, this changes the distribution of forces over the disc material and the vertebrae starts to grow small bone spurs to aid in the stability of this particular bony segment of the spine. More tears may or may not occur within the outer disc fibres progressing the degeneration process. As we age, the fluid content of the disc material begins to decrease affecting the height of the disc. As the height decreases, the disc material will begin to push outwards. Disc material in combination with bone spurs can add extra pressure to the nerve root which is exiting the spine at the degenerative level. Very small increases in pressure on the nerve, can cause significant levels of pain.
This is a condition that takes many years to develop. Initially, one may experience an episode of acute low back pain. Pain can be localized to the back or you may have referred pain down into the buttock or leg. In most cases, this patient will recover fairly quickly and will return to normal activities. This particular patient may experience one or several more episodes throughout their life. After the age of 50, this patient may experience a more prolonged period of low back pain, or low back pain that doesn’t completely go away. The symptoms tend to be very similar to a disc bulge, moderate to severe leg pain with or without low back pain.
Chiropractic treatment is going to initially focus on pain control by decreasing inflammation. Once the pain is manageable, treatment will involve more introduction of movement through some form of spinal manipulation, exercise and muscle treatments (ART, Graston, massage,etc…). In addition, education will provide self treatment options, proper ergononmics and exercise technique. An important concept to remember with DDD is that treatment does not reverse any of the anatomic changes that occur, but helps manage the symptoms.
Degenerative Joint Disease
With this condition, there is a similar process that is occuring, but at a different location on the vertebrae. The anatomical structure involved in DJD is the facet joint. There are 2 facet joints at each level in the spine that allow the vertebrae to move within 6 different ranges of motion. The facet joints are synovial joints filled with synovial fluid and surrounded by ligamentous tissue. When there is an increase in pressure on the facet joints by postural changes that cause the weight of the spine to be forced posterior off of the discs, as is seen in an increased lumbar curvature or hyperlordosis, bone will start to grow bone spurs as a means to increase stability and help distribute the weight.
Bone spurs can push on the nerve roots which travel directly below the joint causing some nerve irritation or pressure. Now we may have some referred pain that accompanies spine pain.
Treatment for DJD is going to be very similar to DDD however, here, the first thing we want to do is work on increasing motion at the joint in combination with decreasing inflammation. Part of the pain source has to do with the joint being restricted in motion, so this is why increasing mobility will be the main form of pain relief. Then the focus will be on corrective exercise to help change the weight distribution back to the disc to remove the pressure on the joints. Again, treatment isn’t going to reverese the bony changes that have already occured, but treatment can prolong the mobility of the joint and slow the progression of degeneration.