DDD at L4/5- what does it mean?

[chris67bug]

Hi - hope someone can advise me.

I've been suffereing from minor back pain mainly when sitting at my desk at work for about the past 2 years. It never really bothered me until the the beginning of the year when my father passed away and my back became very sore. I attributed this to stress and hoped things would return to normal.

However things havent improved and I got an MRI done last week and it was found that I have degenerative disc disease in L4/L5. There is a left sideded posterior annular tear in the same disc. The other lumber discs seem to be normal.

Basically I'm wondering if this could have been the result of a trauma in the past. I hurt my back about 5 years ago, putting rubble into a skip using a wheelbarrow. Basicallly I got stuck half way up the plank and had to set my foot down on the ground to steady myself- I'm guessing I must have twisted myself as when I next bent over, my back 'went' and I was in considerable pain. The back did seem to heal in a week with no further pain for several years.

I would very much like to hear from anyone who could advise me. I've always been an active person, I did weight training for years also which may not have helped my back much either. I am now worried about doing anything physical in case I hurt my back more and to be honest rather frightened for what the future holds for me.

chris

[gcoe]

Hi chris67bug

MRI results like this are common. In the general population without back pain it is quite common to find disc changes like this. There is also a poor correlation between the presence of such changes and back pain. So just having the presence of degenerative disc disease in L4/L5. with a posterior annular tear in the same disc may or may not be responsible for the pain you have. Seeing this on imaging is not proof of cause of pain.

It would be impossible to say whether this is a result of a previous event or not. However these changes are VERY common in the general population so this makes it even harder to tell "cause and effect".

It is also true that there is very poor correlation between the severity of disc changes changes and severity of pain. You can have a lot of persistant and recurrent pain and the pain can be quite intense yet there be very few changes on imaging and vice versa.

There is no evidence that I know of that previous weight training would predispose you to back pain or degenerative changes. That is not to say that all weight training techniques are safe or that the more extreme end of training (eg professional weight lifting) there may not be some increased risk of changes.

In contrast sedentary lifestyle may not be good for back pain and there is some evidence that "getting fit" in the presence of chronic low back pain is actually helpful.

I've always been an active person, I did weight training for years also which may not have helped my back much either. I am now worried about doing anything physical in case I hurt my back more and to be honest rather frightened for what the future holds for me.

It is quite likely that your fears are unfounded. Participating in normal physical activity may actually do such tissues more good than harm. In fact the fear of injuring oneself (sometimes called "fear avoidance beliefs") is actually more of a problem when it comes to back pain. People who develop back pain and who harbour these beliefs and fears often appear to get into a downward spiral of avoiding activity and getting more disabled.

The general wisdom nowadays is to get fit and keep fit. this is important for managing/preventing other health issues that in the end are far more salient to your health than back pain (heart disease, cancer, diabetes, obesity etc - the big killers) . However if you are worried about proceeding with this (for example "how do I manage physical activity if it is making me more sore?"), want some more specific advice then I would go and get help from a physio who is experienced at dealing with chronic back pain and who can work with you as you resume activity. Based on an assessment of your and your back they can advise on specifc exercises and on general issues with resuming a balanced fitness programme.

If you find your thoughts and feelings are really getting in the way of what you want to do then "cognitive-behavioural therapy" - a technique developed by psychologists for talking your way out of these thoughts - has been shown to help people with chronic low back pain. Please note I am not suggesting your pain "is in your head". But we do find this link between unhelpful thoughts and being more disabled by back pain

[chris67bug]

Thanks for taking the time to post such a detailed reply GCOE, you have certainly helped address some of my fears. I do agree that in my case, some of my 'symtoms' probably stem from anxiety.

I am taking active steps to work with this problem, and will be seeing a reputable physio at the end of the week to discuss treatment and exercise.

One last question- I've read about the McKenzie method for treating disc bulges, just wondering what others think of these exercises?

chris

[gcoe]

Hi chris67bug

Glad you found it useful. I think it is quite normal to feel that way. After all our natural inclination is that when we are in pain that there is something wrong and if we do something that makes the pain worse we therefore must be doing physical damage. Then when you get a diagnosis of disc damage it is easy to consider the worst. In reality when it comes to back pain it all seems a bit more complicated than that

The McKenzie Method is an approach to managing pain that has some good evidence for it. A nice thing about it is that you know if you are going to respond to it fairly quickly and the physio can soon teach you how to manage it yourself. Based on the physio's assessment, it usually involves a series of repetitive movements of the spine in the "desirable direction" and education of posture and movement. A large number of physios will include the testing used in the that approach in their standard exam, but you could ask your physio if he/she uses the method and whether it would be helpful in your case.

so by all means give it a go. Personally I would tend to combine it with a more general fitness programme which is oriented to things that suit you and your lifestyle. Keeping fit, aerobically, and keeping your muscles in strong, including your spine and extremities is all good, along with exercises to maintain a better posture. This might be relevant to you if you have become more sedentary due to taking up a desk job.

[chris67bug]

Thanks again GCOE. I attended physio today and got some traction. Her advice was similiar to your own- try the Mackenzie method but also other physical activities. I am much heartened by this and feel I can do something to manage this condition.

Thanks again

chris

[chris67bug]

Just a few more questions!

My MRI also showed up the presence of bone spurs at the rear of the vertabra (where the nerve root exits). Just wondering if anyone knows how long these take to grow- I assume they arent something that occur in a matter of months.

The other question is about the annular tear- could it have caused the disc degeneration at L4/5 or is it the other way round- ie the damaged disc became brittle and then tore.

The final question is a minor one- one website recommends sitting on an exercise ball and bouncing gently for 5 mins each day- is this safe? The idea is that this motion will help the discs receive blood and oxygen.

Thanks

chris