How To Keep Spinal Discs Healthy

What are intervertebral discs? 

Intervertebral discs, also called spinal discs, are fibrocartilage structures that separate the vertebrae along the spine. They act as shock absorbers and allow for more smooth movement throughout the spine (1), and there are 23 in total (2). 

Their structure is made up of a tough fibrous outer ring called an annulus fibrosis and a softer inner core called the nucleus pulposus (1). A common misconception is the analogy of discs being like a jam donut. However, discs are more like a tire truck filled with chewing gum (3) and they are extremely strong! 

What can happen to our discs and why? 

Normal changes in the discs do occur over time, much like our hair going grey and wrinkles on our skin. Age related changes include loss of fluid and changes in structure (1). These changes can be referred to as a condition called Degenerative Disc Disease (DDD) however this term can be misleading as the changes are more age and genetic related than disease related (4, 6).  

Tears and cracks can appear in the annulus fibrosis allowing the inner nucleus to seep through. This can lead to neural inflammation and can increase instability within the spinal structure. The neural inflammation is thought to be the main driver of painful symptoms, and the instability within the spine can lead to protective muscle spasm (1, 4). Most common symptoms are neck and low back pain, with radiation into the shoulder, arm and hand, or buttocks, legs and feet (1).

(8)

Not everyone however will experience symptoms due to these age-related changes (4). In a recent study, it was found that disc bulging was frequently observed on magnetic resonance images (MRI) in asymptomatic subjects regardless of age (5).  

Risk factors for developing DDD include age, genetics, obesity and smoking. Alcohol consumption, diabetes and hypertension have also been linked (7). Evidence also suggests that while extreme sports may accelerate DDD, moderate activity seems to protect the spine (7).  

So, what can I do?

Well, I’m quite partial to a phrase or two, and my favourites include ‘Rest is rust, motion is lotion’, ‘If you don’t use it, you lose it’ and ‘You can’t go wrong getting strong’. While you can’t change your genetics, you can help your discs by keeping active and strong. A recent 2020 study showed that physical inactivity was closely linked to an increase in developing DDD (7).  

Obesity can affect the discs both due to the increased mechanical stress due to the extra weight and from dietary increased inflammation within the body (7). Maintaining a healthy body weight can help reduce this risk. Smoking is known to restrict blood flow and thicken the blood vessel walls which may result in reduced nutrition for the discs (7).  

Common conservative modalities used to treat DDD and low back pain include anti-inflammatory medications and steroid injections (4). These can provide short term relief but don’t resolve the underlying problem.  

Education and advice are also extremely important as psychological effects are closely linked to DDD. Back pain can lead to thoughts like ‘my back is weak’ or ‘I’m going to have this pain forever’ but neither of these statements are true (4). Studies have shown that discs, like our muscles, adapt to different loads placed on them (6). If we don’t load enough, we could be at risk of developing DDD. High loading at low volume with low frequency has been shown to help induce regeneration of discs – even once a week can help (9). 

Exercises should include movement of the spine through comfortable ranges of flexion and extension. These can include pelvic tilt exercises, glute bridge, plank and squat (4). There is no such thing as a ‘bad exercise’, so my advice is always to find movement and exercise that you love to do and that doesn’t increase your pain. You’ll be much more likely to be compliant with exercising if you are doing something you love.   

Recap

Spinal discs function as shock absorbers and help aid movement throughout the spine. They are not weak! Genetics and age are the biggest risk factors for developing DDD but lifestyle changes and loading have been shown to help regenerate discs and keep them healthy.  

If you are concerned about spinal disc pain, be sure to speak to a Chartered Physiotherapist to get the issue diagnosed and treated.

References

  1. https://www.medicalnewstoday.com/articles/266630
  2. https://www.physio-pedia.com/Intervertebral_disc
  3. The Sports Physio, Adam Meakins
  4. https://www.physio-pedia.com/Degenerative_Disc_Disease
  5. Hiroaki Nakashima et al. Spine (Phila Pa 1976). ‘Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects’. 2015.
  6. Ruffilli et al. Int J Mol Sci. 2023 Feb; 24(3): 2728 ‘Mechanobiology of the Human Intervertebral Disc: Systematic Review of the Literature and Future Perspectives’. 2023.
  7. Maurer et al. The Spine J. Vol 20 (9). ‘Long-term effect of physical inactivity on thoracic and lumbar disc degeneration—an MRI-based analysis of 385 individuals from the general population.’ 2020.
  8. https://www.physio-pedia.com/Disc_Herniation
  9. Steele et al. The Spine J. Vol 15 (10). ‘Can specific loading through exercise impart healing or regeneration of the intervertebral disc?’ 2015.


Ergonomic InjuriesMary Doylespinal discs, spinal disc injury, spinal health