Integrative Treatment for Degenerative Disc Disease

Degenerative Disc Disease, called DDD, refers to a condition resulting from worn down vertebral discs in the spinal column.  These discs occupy the intervertebral space and serve to cushion the vertebrae.  They act as shock absorbers that enable bending and twisting of the spine.  The discs can wear down because of injury, the natural aging process, genetic factors and certain activities.  In some cases the disc will herniate and the semi-fluid substance occupying the middle will protrude outside of the disc wall applying pressure on the nerves and causing extreme pain.  In severe cases the discs wear down completely causing bone on bone contact and the development of arthritis in the adjacent vertebrae.  Not all people with degenerative discs will experience pain and after 40 years of age the majority of people will have some amount of degeneration.  An important aspect of the anatomy and physiology of vertebral discs to consider is they receive almost no blood supply and are therefore unable to heal or repair themselves after being damaged.  This can make them more complex to treat and challenging for patients who experience damage to them early on in life either from activity or a traumatic injury.  (Degenerative disc disease).

In Traditional Chinese Medicine, degenerative disc disease results from bi syndrome, also known as stagnation or painful obstruction syndrome which is caused by an obstruction of qi and blood in the channels.  In the case of DDD, this obstruction occurs in the governor vessel as well as the bladder channel due to an external pathogenic invasion such as wind, cold, heat and/or dampness (zhu et al., 2020).  This invasion can results from a constitutional deficiency or an injury that compromises the integrity of the disc and channel making it more susceptible to pathogenic invasion.  It is also worth considering the concept of Jing deficiency as a contributing factor to degenerative disc disease.  In TCM theory, Jing is stored in the Kidneys and is the essence of yang.  Kidney yang deficiency is a common cause of degenerative disc disease.  Kidney yang and jing depletes naturally over time with age.  This process can be accelerated by illness, surgery, injury or lifestyle factors.  Additionally, Kidney yang is determined by an individuals innate constitution.  (Fratkin, 2018).
An important and effective modality to manage pain from degenerative disc disease is physical therapy.  Physical therapy enables people to move safely while focusing on mobility necessary for their daily lives.  It restores and preserves range of motion.  It supports and maintains fitness while helping to build strength and flexibility.  Physical therapy incorporates exercises that are protective and promote proper body mechanics and posture.  Part of what makes physical therapy an effective modality is it is performed by an extensively educated and experienced therapist that uses observation, inquiring and clinical training to create a treatment plan that bests suits each patients individual needs.  Although disc degeneration may be the root cause of someones pain and mobility issues, the physical manifestations will vary and it is important to customize each patients care in order to achieve the best outcome.  (Physical therapy for arthritis).
Massage therapy is a valuable tool for people suffering with pain from disc degeneration.  Massage therapy is a broad term that includes a variety of styles and techniques with varying origins.  Generally massage therapy helps to loosen soft tissues, calm muscles spasms, increase blood and lymphatic flow and induce relaxation.  For individuals struggling with constant muscle spasms resulting from disc issues, it can be a wonderful way reduce or eliminate these uncomfortable contractions and enable healthier and safer movements.  Studies demonstrate massage therapy provides immediate and short term relief from chronic and acute lower back pain as well as increased mobility.  (Brosseau et al., 2012).
Self-Care is an essential part of managing DDD and offers accessible and simple solutions to patients living with chronic pain.  Heat therapy helps relax muscle spasms and increases blood flow.  It also promotes general relaxation and rest that can have a restorative and anti-inflammatory effect.  Ensuring adequate sleep, maintaining a health weight and employing relaxation techniques all have a positive affect on pain symptoms related to DDD.  It is also very important people follow the exercises recommended by physical therapists and refrain from activities and movements that increase or trigger pain.  (Williams, 2017).
The modalities explored all offer a form of non-surgical spinal decompression therapy.  Essentially they are gentle and non-invasive ways to stretch the spine and intervertebral spaces to reduce pressure and alleviate pain, while also helping the discs and surrounding tissue to heal and restore.  One study shows clinical and radiological evidence of reduced pain, improved mobility and reduction in the size of disc herniation in patients that received multiple forms of non-surgical spinal decompression including electrotherapy, massage and targeted exercises (Demirel et al., 2017).
Platelet Rich Plasma therapy, called PRP for degenerative discs is growing in popularity amongst patients and medical providers.  It can be injected in varying locations to treat a variety of musculoskeletal pain and more recently is being injected directly into the intervertebral space to treat degenerative disc disease.  Platelet rich plasma is extracted from the patients blood through centrifugation and works by releasing a variety of growth factors, increasing cellular reproduction, angiogenesis and producing extracellular matrix.  PRP therapy has been shown to have regenerative affects on the disc while reducing pain severity and improving functionality.  (Bhoi et al., 2021).

Stem cell therapy for DDD is administered in a similar way to PRP in that it is injected directly into the disc.  Mesenchymal stem cells, (MSC) are extracted from bone marrow through centrifugation.  MSC’s have the potential to differentiate into various types of cells as well as release growth factors, cytokines and substances that enhance immune function and therefore have potential in treating degenerative diseases.  Several animal studies demonstrated the capacity off MSC’s to regenerate discs when injected directly.  A study involving human patients with disc related back pain showed improvement in the severity of discomfort after receiving stem cell therapy.  Additionally, magnetic resonance imaging (MRI) confirmed an increase in disc hydration as a result of stem cell injections.  (Bhoi et al., 2021).

My Personal Experience treating pain with East Asian Medicine:

East Asian medicine offers many effective methods to treating and managing pain caused by degenerative disc disease.  Acupuncture, herbal medicine and body therapies including cupping, gua sha and tuina help to support the spinal column and surrounding tissues.  Compromised discs cause increased pressure on the spinal column and surrounding muscles will compensate and spasm in order to protect the integrity of the spine and nervous system.  This can result in painful tension, long-term holding patterns, poor posture and compensation; all factors that perpetuates the pain cycle, inhibit blood flow, produce muscular adhesions and cause inflammation.  In the case of degenerative discs, the pain may be originating in an isolated area but overtime the whole body may be effected.  A helpful visualization is imagine pinching a piece of fabric that is laid out flat on a table.  Only a small area is being pinched but the entire fabric gets pulled in result of the pinched area.  This is how the body responds to compromised support in the spinal column.
Acupuncture can provide instant pain relief and relaxation as well as improve mobility and function over time.  Not only is it a fantastic way to resolve the stagnation of blood and qi that causes pain but it can also strengthen underlying deficiencies contributing to the disc degeneration.  It can be used to clear obstructions in the effected channels and also to tonify Kidney yang and conserve essence.  (Bhoi et al., 2021).
Acupuncture enables the mind and body to relax which reduces pain symptoms and eases the physical and mental tension resulting from the pain cycle.  Sometimes the first step to reducing pain is breaking the pain cycle.  It also increases blood flow and circulation which benefits the health and function on the anatomy and physiology both locally and holistically. (Ilieva et al., 2018).
Herbal medicine works internally to nourish the blood and qi which provides support to the patient on a biochemical level.  To achieve maximum results it is important the patient is consistent and patient with their herbal prescriptions, some take months to be fully effective.  There are single herbs and formulas that move the blood and qi, providing a great amount of pain relief especially when taken over the course of a few months.  Over time patients experience a noticeable difference in their daily pain experience and often times resolve the majority of symptoms.  Additionally there are also herbs that conserve and astringe essence and jing as well as support Kidney yang.  Tu Si Zi-Cuscuta is an herb that does just that and a fantastic option for patients with disc degeneration. (Individual herbs).
Asian body therapies such as cupping and gua sha help to remove stagnation from the system quickly and offer fast relief for patients.  These therapies are potent yet gentle when done correctly and compliment herbal medicine and acupuncture.  Patients have positive immediate and long term outcomes when both therapies are utilized in treatment.
Overall, degenerative discs can cause challenging pains conditions that require continued management and care.  Other than a disc replacement there is no way to entirely cure or fix a disc that has been damaged or degenerated and the naturally aging process only poses further challenges to patients and practitioners.  The best approach is multi-faceted, individualized and supports the patients overall health. The best approach is to establish what works for the patient by trying out different options, receiving feedback and analyzing outcomes.  Employing East Asian medicine with other adjunct therapies that best suit the patients personalized needs offer promising solutions to managing and alleviating pain from degenerative disc disease. 

References:

Bhoi, D., Jain, D., Garg, R., Iyengar, K. P., Hoda, W., Vaishya, R., & Jain, V. K. (2021, April 29). Complementary and alternative modalities (CAM) for pain management in Musculoskeletal diseases (MSDS). Journal of clinical orthopaedics and trauma. Retrieved November 8, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113975/

Brosseau, L., Wells, G. A., Poitras, S., Tugwell, P., Casimiro, L., & Novikov, M. (2012, June 23). Ottawa panel evidence-based clinical practice guidelines on therapeutic massage for low back pain. Journal of bodywork and movement therapies. Retrieved November 8, 2022, from https://pubmed.ncbi.nlm.nih.gov/23036876/

Degenerative disc disease. Degenerative Disc Disease | Arthritis Foundation. (n.d.). Retrieved November 8, 2022, from https://www.arthritis.org/diseases/degenerative-disc-disease

Demirel, A., Yorubulut, M., & Ergun, N. (2017, September 22). Regression of lumbar disc herniation by physiotherapy. does non-surgical spinal decompression therapy make a difference? double-blind randomized controlled trial. Journal of back and musculoskeletal rehabilitation. Retrieved November 8, 2022, from https://pubmed.ncbi.nlm.nih.gov/28505956/

Fratkin, J. P. (2018, October 23). Boosting Kidney Yang and Jing. Dr. Jake Fratkin. Retrieved November 8, 2022, from https://drjakefratkin.com/boosting-kidney-yang-and-jing/

Ilieva, V., Zhu, J., & Arsovska, B. (2018, January 7). Acupuncture Treatment in Patients with Lumbar Degenerative Disc Disease and Hip Pain. Core. Retrieved November 9, 2022, from https://core.ac.uk/download/pdf/149219791.pdf

Individual herbs. Tu Si Zi - 菟丝子 - Semen Cuscutae - Chinese Herbs - American Dragon - Dr Joel Penner OMD, LAc. (n.d.). Retrieved November 9, 2022, from https://www.americandragon.com/Individualherbsupdate/TuSiZi.html

Physical therapy for arthritis. Physical Therapy. (n.d.). Retrieved November 8, 2022, from https://www.arthritis.org/health-wellness/treatment/complementary-therapies/physical-therapies/physical-therapy-for-arthritis

Williams, R. S. (2017, June 30). Degenerative disc disease: Treatment options. Costal Orthopedics. Retrieved November 8, 2022, from https://www.coastalorthoteam.com/blog/degenerative-disc-disease-treatment-options

Zhu, L., Yu, C., Zhang, X., Yu, Z., Zhan, F., Yu, X., Wang, S., He, F., Han, Y., & Zhao, H. (2020, July 29). The treatment of intervertebral disc degeneration using traditional Chinese medicine. Journal of Ethnopharmacology. Retrieved November 8, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0378874120329986