Even though majority of Singaporeans would understand that regular exercise is good for them, there is still a common misunderstanding that exercise could potentially lead to degeneration.
Most of us would know some one with back pain, neck pain, or even knee pain who has been told that they have degeneration in their joints.
This is when things get tricky — “degeneration is wear and tear right?”
“Does that mean I have to watch my exercise?”
The short answers are no and no.
Degeneration is NOT “wear and tear”
If you have heard me say this before, please bear with me.
While chiropractors to orthopaedic surgeons would like you to believe that you have a degenerated knee or disc so they could sell you their services, Rheumatology, arguably the most authoritative scientific publication on the subject matter, has referred to the “wear and tear” narrative as archaic, pejorative, and inaccurate.
You see, we have tons of data to show is that the structural changes we can see on MRI scans or x-rays are more likely to be normal, natural, and age-associated changes.
Our current, and more accurate, understanding of degeneration is closer to having more wrinkles and/or grey hair as we start to age.
It’s totally normal.
I am not saying that spinal disc degeneration cannot lead to disc herniations or “slipped disc” that may impinge on a nerve to give you numbness and tingling down the leg.
I am saying that these are uncommon and over 70% of patients with radiculopathy will experience symptom resolution within a 12-week period.
Can you exercise with degenerative disc disease?
A study published in April this year confirmed that not exercising in the long-term may increase your chances of having disc degeneration.
What I want to point out is that our beliefs surrounding exercise and disc degeneration may be wrong!
In this study, 385 participants were followed for a period of 14 years. After taking into account their age, gender, body weight, and existing health issues such as high blood pressure and diabetes, those who exercised less showed increase in disc degeneration of both the thoracic and lumbar spine.
This paper defined physical activity as those who regularly exercised for 2 or more hours a week. Those who exercised irregularly or regularly for an hour are deemed to be physically inactive.
Does degenerative disc disease cause back pain?
This study also found that the degree of disc degeneration also did not have any influence on the participant’s back pain. This again goes to support that degeneration is a normal, age-associated change.
Like how grey hair doesn’t give your headaches, degeneration doesn’t give you back pain.
How does obesity affect the spine?
There was a previous study (2013) that was able to demonstrate that obesity had an influence on disc degeneration.
This study was interesting because it did not use body weight as a measurement for obesity. Instead, they measured waist circumference and obesity measurements calculated via MRI scan.
In all measurements, obesity was linked to an increase in lumbar disc degeneration.
This is interesting because it’s telling us that you don’t need a MRI or x-ray to check out your lumbar discs health. It’s possible that you can gauge your risk for spinal disc degeneration by just looking at waist circumference or body fat percentage alone.
The benefit of exercising on spinal disc health that is observable in non-obese population doesn’t seem to transfer to obese people.
This means that overweight individuals who particulate in regular exercise (2 or more hours a week) doesn’t seem to experience less degeneration compared to those who are sedentary.
If you are overweight and you are worried about your disc health, research is suggesting that weight loss may be more effective at keeping your discs healthy than exercise alone.
What kind of exercise is good for degenerative disc disease?
This is probably the multi-million dollar question.
There isn’t really a lot of data out there on what works or what doesn’t work. Tai Chi and cycling are both identified to be helpful at maintaining disc health.
A small study published in 2014 found that Tai Chi practitioners with over four years of experience had less degenerative changes to the lumbar spine than those who did not practise Tai Chi. The authors attributed the benefits of Tai Chi to increase strengthen and stability.
To a huge extent, I see how stability can improve with Tai Chi. Strength? Not so much. Tai Chi is a body weight only training. It’s unlikely that a healthy individual can achieve significant improvements in strength from Tai Chi alone.
Cycling is considered by many health care professionals to be a joint-friendly sport. A 2019 study compared experienced high-volume cyclists (150 hours per week for at least five years) to sedentary individuals and found the cycling group to have better intervertebral disc hydration and glycosaminoglycan content (protein that contributes to the gel-like characteristic of spinal discs.
The researchers also found cyclists to have have higher intervertebral disc space WITHOUT any degeneration findings in the spine.
Cycling vs running?
Despite the commonly held believe that cycling is better than running because of its lower impact, a group of researchers was able to demonstrate that running improved spinal disc hydration, proteoglycan content, and intervertebral disc height.
Curiously, longer distance runners had more disc height increase than those who ran shorter distances!
In a study examining spinal disc in rats, it was found that three weeks of running resulted in higher cell proliferation and production of extracellular matrix in spinal discs.
We think that high impact sports is worse for our spine or our intervertebral discs. Some of us even think that exercise can cause slipped disc. However, research is suggesting that that may not be true.
What helps back pain from degenerative disc disease?
Again, there’s tons of data to suggest that back pain and spinal degeneration have very POOR correlation. Enough for us to think that your back pain is not likely to be coming from the degeneration in your spine.
If you are not convinced by these data sets (more 3,000 subjects), then perhaps consider exercise.
At the very least, we know that tai chi, cycling, and running have been associated with improved disc health and in some cases increased the spinal disc space between your vertebra.