Degenerative disc disease, black disc disease, dehydrated or desiccated discs. When faced with these seemingly bleak diagnoses you may wonder if there is anything you can do to have healthy discs again?
Knowing that these diagnoses indicate a lack of hydration:
Could a type of food help?
Is there a vitamin to take?
Or should we simply drink more water?
Up until recently the answer was an unequivocal “we don’t know”. There was little to no research directing us in how to heal or improve the health of your disc. The widely-held view in the spine community is that the disc as a structure, unless protected, only gets worse.
That is until a study recently published in Scientific Reports convincingly demonstrated that discs are like many other tissues in the body. Stress them and they get stronger. The key message is that if you walk, jog or run – the right amount – your disc becomes more hydrated!
Discs are better when they are stressed
How much is enough?
Before getting on the bandwagon and starting a running routine, the question to consider is how much is enough and what is too much. Up until now, running was perceived by the spine treatment community as injurious to the discs. We medical-types watch the joggers, cringing at the stresses they put through their joints. The high level of compression generated with every step sounds to us like nails on a chalk board.
Looking at articles published on the forces associated with running provides some insight as to why the medical community thinks the way we do. Many articles have looked at the ground force[1] generated when we run. Ground force is a measure of how hard we hit the ground. An average jogger is estimated to hit the ground at a minimum of 3x body weight whereas the 100 M sprinters generate upwards of 7x body weight. Calculate the forces for a 150-lb. person and the math tells the story. The pressure ranges from 450 lb. to 1050 lb. for every step they take. It’s no wonder that the medical community’s general perspective is that running is ill-advised for our spine’s health.
Tissues adapt to stress
Discs improving with exercise represents a seismic shift for the spine community. Up until now we have only looked at what harms the disc. However, when we look at the science of physiology this conclusion seems logical as it is supported by our knowledge of how other tissues function. We know that for many tissues in the body there is an optimum level of stress. Do too little or too much and your tissues won’t be healthy.
We explored this concept last month in my article on Delayed Onset Muscle soreness (DOMS) [2] and its relation to injury. The concept of strain causing muscles to adapt is well known. We understand that if we exercise the right amount we become stronger. If we exercise too hard or repeat a stress before our muscles have had time to recover these tissues weaken and ultimately damage (tear, sprain, etc.).
We also know this principle holds true for the bones. The oft-quoted Wolff’s law states “bones conform to the stresses placed on them”. This principle forms the basis of exercise treatment used in osteoporosis and bone fracture prevention.
The same can be now said about your discs. Put the right amount of strain on the tissue and your discs will adapt and strengthen, too much and they dehydrate.
The science behind pushing your disc
The walking effect is not surprising. For decades we have known that this is one of the best treatments for back and neck pain. What we haven’t known is why. In this Australian study the results were confirmed using MRI. Applying a T2 protocol, where the water in the disc is white, they measured the T2 times[3] and the glycosaminoglycan[4] content. These proven measures of disc hydration were better in the group that exercised regularly at the optimum intensity.
This study gives insight into what can make our discs better. To be healthy the disc needs to be stressed. But the most important point is that the stress needs to be at the right amount. The researchers called this the “right anabolic window”.
When it comes to exercise there are two basic ways to work out. The steady paced aerobic workouts or the anabolic programs where the intent is to create an oxygen deficit. This anabolic deficit is the principle behind the current trend of short, high intensity bursts. Based on this study it is now the principle to follow to stress the discs.
The key to using an anabolic approach is to not incur too much of an Oxygen deficit. Fortunately, this study gives us the ideal stresses to promote a healthy disc. They found that when the movement was too slow (<1.5 m/sec) the hydration in the disc did not improve. When the movement was too fast (>2.5 m/sec.) the disc hydration worsened.
How to strengthen your healthy discs
Consider speed
You need to apply the right amount of strain. Target the optimum anaerobic window of between 1.5 m/sec and 2.5 m/sec. This means you should set a pace of between 7 and 11-minutes per kilometer. At our clinic, we are measure your speed of walking to determine your baseline. Once we know if you need to slow down or speed up we provide choices to help you maintain the optimum speed.
Consider age
This study was conducted on 25 to 35-year-old, experienced runners. If you are over the age of 35 and/or not a regular runner, get advice before you start. Imbalances, postural problems and/or weakness can change your health initiative into a recipe for injury. Articles show that running shoes that apply excessive stresses is a major factor in a wide range of running injuries.
Consider distance
This study looked reviewed a range of distances. The minimum they considered was 20 km. per week and this distance was sufficient to see an improvement. Some runners did in excess of 50 km. per week and providing the speed was within the optimum rate there was no negative impact on the disc.
Consider injury
If you are coming off an injury, consider seeing your health professional prior to starting your program. Have them assess for imbalances and prepare a program to correct any lurking problems before your healthy initiative is derailed into a painful injury.
Consider your baseline fitness
Many of us have just come off an inactive winter. If you have been less active then start your program a bit slower or see your fitness professional for an assessment prior to starting your program.
Where to start
There is still a lot more research to do in this area and we hope that these scientists have just gotten started. We have yet to see what the impact of exercise is on people with known disc degeneration but this looks promising as we know that exercise is one of the most effective tools in improving physical function with low back pain. This study is an amazing start into prevention of degenerative disc disease and ultimately should help us with tailoring your exercise programs to help you heal your discs.
Who to see
To get started if you are otherwise healthy but inactive and need help in implementing these recommendations into your exercise program, see a member of our therapeutic fitness team, John Gray will help you to know whether you are within the therapeutic range when you exercise. If you are injured or coming off an injury we recommend seeing one of our physiotherapists to look for imbalances prior to resuming a full and active exercise program. Taylor Sipos is our go-to physiotherapist for analyzing your walking or running techniques to reduce risk of injury.
Contact us at 416-925-4687 to book an appointment or go to www.orthophysio.com to read more on these topics.
[1] There have been a variety of reports on ground forces, all indicate high pressures with running
[2] Delayed Onset Muscle Soreness
[3] T2 times have been shown to correlate with water and proteoglycan content in the disc.
[4] Glycoaminoglycan’s are protein and sugar based substance found in the disc. One of its function is to promotes water to return into the disc.The pressure of our body on the disc encourages water to leave the disc resulting in the well known phenomena of being taller in the morning that at the end of the day.
