Degenerative Disc Disease: What the Diagnosis Really Means
Few phrases on an imaging report sound more unsettling than degenerative disc disease. The name can suggest that the spine is damaged and destined to deteriorate. In reality, it describes changes in the spinal discs that become increasingly common with age and are often found in people who have no pain at all.
Discs can contribute to neck or low back pain, but an MRI finding alone cannot identify the source of someone’s symptoms. Genetics, age, previous injury, smoking, physical conditioning, occupational demands, sleep, and overall health may all influence how the discs change and how the person experiences pain.
This article explores what degenerative disc disease means, how spinal discs function, how imaging findings should be interpreted, and how treatment and rehabilitation can help.
The Good News
Degenerative changes do not determine how much pain you will experience or what you will be able to do. Although treatment cannot make an ageing disc look young again, many people can reduce pain and improve mobility, strength, and function.
An individualized approach may combine education, progressive exercise, activity modification, and manual therapy when appropriate. The objective is not to chase every finding on a scan, but to help you move with greater confidence and return to the activities that matter.
Article Index
Understanding Degenerative Disc Disease (DDD)
Degenerative disc disease is not a single disease with a predictable course. It is a broad term used to describe age-related or acquired changes in one or more intervertebral discs, most commonly identified in the mobile cervical and lumbar regions.
These changes may include:
Reduced water content within the disc
Small fissures in the outer annulus
Changes in disc height or shape
Alterations in the adjacent vertebral endplates
Disc bulging or displacement
As disc height and load distribution change, the nearby facet joints may experience different mechanical demands. Osteoarthritis, ligament thickening, and bone spurs may develop as part of the spine’s adaptation to these changes.
This sounds concerning, but structure and symptoms do not follow a simple one-to-one relationship. Many people have substantial degeneration without pain, while others experience significant symptoms with relatively modest imaging findings. Degenerative changes may contribute to localized pain, stiffness, or nerve irritation, but they do not automatically mean that the spine is unstable, damaged, or destined to worsen.
The Vital Role of Intervertebral Discs
Intervertebral discs sit between the vertebral bodies and account for roughly one-quarter of the spine’s height. They act less like simple cushions and more like adaptable load distributors, deforming as we bend, twist, lift, walk, and rest.
Each disc has three closely connected components:
Annulus Fibrosus: Concentric layers of collagen fibres that surround the disc and resist tension, rotation, and shear.
Nucleus Pulposus: A water-rich central region that helps distribute compression across the disc.
Cartilaginous Endplates: Thin interfaces between the disc and adjacent vertebral bodies that help transmit load and allow nutrients to enter the disc.
Discs have only a limited direct blood supply, primarily around the outer annulus. Much of their nutrition depends on diffusion through the vertebral endplates. Loading and unloading throughout the day also changes their water content, which is why discs are slightly fuller after sleep and lose some fluid as the day progresses.
Together, the discs provide spacing between vertebrae, distribute force, and contribute to spinal movement. Degenerative changes may alter these functions, but they do not automatically make the spine weak or painful.
Ageing, Degeneration, and Pain
Spinal discs change throughout life. They gradually lose water and proteoglycan content, their collagen structure changes, and small fissures may develop within the annulus. Some discs also become thinner or less flexible.
These changes exist along a spectrum. The term degenerative disc disease is generally used when disc changes are thought to be clinically relevant, but an MRI cannot determine that by itself.
Common imaging findings include:
Reduced disc hydration
Loss of disc height
Annular fissures
Disc bulging or herniation
Vertebral endplate changes
Osteophyte formation
A degenerative disc may distribute load differently, which can influence the adjacent vertebral endplates, facet joints, ligaments, and muscles. In some cases, inflammatory signalling, endplate changes, or nerve growth into normally less-sensitive regions of the disc may contribute to pain.
However, these findings are not automatic “pain generators.” Their importance depends on whether they correspond with the person’s symptoms, examination findings, neurological status, and functional limitations.
What Asymptomatic MRI Studies Reveal
A 2015 study by Nakashima and colleagues examined cervical MRI scans from 1,211 adults without symptoms. Disc bulging was found in 87.6% of participants. Even among those in their 20s, bulges were identified in 73.3% of men and 78.0% of women. The frequency and severity increased with age.
These figures do not mean that imaging is unimportant. They show why imaging must be interpreted in context. A disc bulge or degenerative change may be relevant, incidental, or one contributor among several.
The scan shows anatomy. The clinical assessment determines whether that anatomy helps explain the person’s pain and loss of function.
Diagnosis: Connecting the Findings to the Person
Degenerative changes are common, so identifying them is not the same as identifying the source of pain. Assessment begins by understanding the symptoms, their onset, aggravating and relieving factors, neurological features, functional limitations, general health, and personal goals.
The physical examination may assess:
Spinal movement and symptom response
Strength, sensation, and reflexes
Nerve-root tension or compression
Hip, shoulder, or adjacent-joint function
Balance, gait, and functional movement
Circulation when symptoms suggest a vascular cause
No single orthopedic procedure can confirm that a disc is painful. The clinician looks for a pattern in which the history, examination findings, and functional limitations make anatomical and neurological sense together.
The following videos demonstrate components of this broader assessment.
Orthopedic Testing
This video demonstrates orthopedic procedures used to examine common causes of low back pain. The findings can help identify painful or restricted movement and distinguish among possible contributions from the lumbar spine, hips, SI joints, and surrounding tissues.
Orthopedic testing narrows the possibilities but does not identify a painful disc with certainty.
Lower Limb Neurological Examination
This video demonstrates the assessment of lower-limb strength, sensation, and reflexes. It is particularly relevant when low back symptoms include leg pain, numbness, tingling, or weakness that may indicate nerve-root involvement.
For cervical symptoms involving the arms or hands, an upper-limb neurological examination would be more appropriate.
Peripheral Vascular Examination: Key Considerations
A vascular examination is not routinely required because disc degeneration does not ordinarily impair peripheral circulation. It becomes relevant when leg pain, cramping, skin changes, diminished pulses, or walking intolerance raises suspicion of vascular disease rather than, or in addition to, a spinal condition.
Imaging: Useful Information, Not a Verdict
Most uncomplicated episodes of neck or low back pain do not require immediate imaging. Imaging is generally considered when symptoms persist, neurological deficits develop, serious pathology is suspected, or the results would meaningfully change treatment decisions.
X-rays
X-rays can show:
Loss of disc height
Osteophytes
Vertebral alignment
Facet-joint osteoarthritis
Fracture or other bony abnormalities
They do not show discs, nerves, or soft tissues in detail and cannot determine whether a degenerative finding is painful.
Magnetic Resonance Imaging
MRI provides the most detailed view of the discs, spinal canal, nerve roots, spinal cord, vertebral endplates, and surrounding soft tissues. It may identify:
Disc dehydration, bulging, or herniation
Annular fissures
Endplate and bone-marrow changes
Spinal or foraminal narrowing
Nerve-root or spinal-cord compression
These findings must match the symptoms and clinical examination. An abnormal MRI does not automatically explain pain, and a relatively modest scan does not invalidate the person’s experience.
Computed Tomography
CT provides excellent detail of bone and may be used when fracture, significant osteoarthritis, or another osseous condition is suspected. It can also be considered when MRI is unavailable or unsuitable, although it provides less soft-tissue detail.
Imaging should answer a clinical question, not simply confirm that ageing has occurred. The scan shows structure. The complete assessment determines what that structure may mean for the individual.
Nonsurgical Care: Building Function Beyond the Scan
Many people with degenerative disc changes can be managed without surgery. Treatment does not need to reverse the MRI findings to improve pain, movement, or quality of life.
An individualized nonsurgical plan may include:
Education and Reassurance: Understanding that degeneration does not automatically mean damage or progressive disability can reduce fear and support confident movement.
Progressive Exercise: Mobility, strength, aerobic conditioning, and functional training help the spine and surrounding tissues manage everyday loads.
Manual Therapy: Joint and soft-tissue procedures may reduce pain or restricted movement and help some patients participate more comfortably in rehabilitation.
Activity Modification: Temporarily adjusting provocative tasks can help manage a flare-up without unnecessarily avoiding movement.
General Health Support: Sleep, smoking cessation, stress management, nutrition, and physical activity can influence pain, recovery, and overall health, even if they do not erase structural degeneration.
The objective is not to make the spine look younger. It is to increase the person’s capacity until daily demands become more manageable.
How Does Nonsurgical Care Compare with Surgery?
Some randomized trials involving carefully selected people with persistent lumbar pain and disc degeneration found that intensive cognitive and exercise-based rehabilitation produced outcomes comparable to lumbar fusion. These studies do not prove that manual therapy and exercise are always equivalent to surgery, nor do they apply to every spinal condition. PubMed
Surgery is not usually considered simply because degeneration appears on an MRI. It may become appropriate when symptoms remain severely disabling despite a well-designed course of nonsurgical care or when specific neurological or structural findings warrant surgical assessment.
Cervical spinal-cord compression requires particular caution. Progressive balance problems, loss of hand coordination, widespread weakness, or changes in bladder or bowel control require prompt medical assessment and should not be managed as uncomplicated disc degeneration.
The decision is not “therapy or surgery” in the abstract. It depends on the diagnosis, neurological findings, functional limitations, previous care, goals, preferences, and potential benefits and risks for the individual.
Manual Therapy: Supporting Movement and Rehabilitation
Manual therapy can be a valuable part of care when degenerative disc changes are accompanied by painful or restricted movement. Its purpose is not to regenerate the disc or correct the imaging findings. It is used to reduce pain, ease stiffness, improve mobility, and help the patient participate more comfortably in exercise and daily activity.
Treatment may address:
Joint Mobility: Mobilization or manipulation may be applied to clinically relevant areas of the spine, hips, pelvis, or thoracic region when restricted movement contributes to the presentation.
Muscle and Soft-Tissue Function: Massage and other soft-tissue procedures may reduce guarding, improve movement tolerance, and address painful tissues surrounding the affected region.
The Broader Kinetic Chain: Examination may identify movement or load-management issues beyond the symptomatic area that influence how the spine functions.
Technique selection depends on the diagnosis, symptom irritability, neurological findings, bone health, medical history, patient preference, and response to care. Manual therapy should support an active rehabilitation plan rather than become the only treatment.
Gentle Chiropractic Care for Degenerative Disc Disease
This video demonstrates lower-force approaches that may be considered for patients with persistent pain, stiffness, or reduced mobility. Treatment frequency should be guided by measurable benefit and reassessment rather than a predetermined maintenance schedule.
Osteoporosis, fracture risk, severe osteoarthritis, previous surgery, and other medical conditions may require substantial modification or make certain manipulative procedures inappropriate. “Gentle” does not automatically mean suitable for every patient.
Cervical Adjustments vs. Mobilization: Your Choice!
Cervical manipulation and mobilization are different ways of applying force to the joints of the neck:
Manipulation: A controlled, high-velocity, low-amplitude procedure applied to a selected joint.
Mobilization: Slower, graded movements performed within a comfortable range.
Both may reduce pain and improve movement in appropriately selected patients. The decision is not based on preference alone. It should also reflect the clinical examination, neurological status, risk factors, treatment goals, and informed patient consent.
In this video, Dr. Brian Abelson demonstrates cervical joint mobilization and explains how the procedure may be adapted to the individual.
These procedures require appropriate professional training and should not be attempted as self-treatment.
Soft-Tissue Therapy: Supporting Movement
Pain, guarding, reduced activity, and altered movement can change how the muscles and connective tissues around the spine behave. Some areas may become tender or tense, while others may contribute less effectively during movement.
Soft-tissue therapy uses targeted pressure and guided movement to address these findings. Depending on the assessment, treatment may help:
Reduce muscle guarding and tenderness
Improve comfortable movement
Address restrictions within the broader kinetic chain
Make exercise and daily activities easier to perform
Soft-tissue therapy does not regenerate a degenerative disc or reverse changes seen on imaging. Its role is to improve the surrounding movement system and help the person participate more comfortably in progressive rehabilitation.
Treatment should be individualized according to the person’s symptoms, examination findings, neurological status, goals, and response to care.
Low Back Release Protocol (MSR)
In this practitioner-focused video, Dr. Brian Abelson demonstrates a Motion Specific Release (MSR) protocol for assessing and treating soft-tissue restrictions associated with low back pain. These procedures may be considered when the examination identifies relevant muscular or fascial restrictions, whether or not degenerative disc changes appear on imaging.
The techniques should form part of a broader plan that includes education, progressive exercise, and regular reassessment.
Fascial Expansion: MSR Low Back Pain Protocol
This practitioner-focused video demonstrates fascial expansion procedures used within the MSR system. The approach draws on applied anatomy, kinetic-chain relationships, and selected concepts associated with acupuncture and traditional Chinese medicine.
These procedures are intended to address clinically relevant soft-tissue restrictions and support more comfortable movement. They should not be interpreted as repairing a degenerative disc or as a stand-alone treatment for DDD. Their value is assessed by measurable changes in pain, movement, function, and the patient’s ability to progress with active rehabilitation.
These manual procedures require appropriate clinical training and are not intended for unsupervised self-treatment.
Exercise: Building a More Capable Spine
Exercise is one of the most important components of managing symptoms associated with degenerative disc disease. It cannot reverse changes seen on imaging, but it can improve mobility, strength, endurance, confidence, and the ability to meet the demands of daily life.
There is no single exercise program that works for everyone. The right starting point depends on whether symptoms involve the neck or lower back, how sensitive the condition is, whether nerves are involved, and which movements feel limited or provocative.
A well-rounded program may include:
Comfortable mobility: Pelvic tilts, cat-cow movements, knee-to-chest stretches, or controlled lumbar rotations can help maintain movement. The direction and range should be guided by how symptoms respond.
Trunk and hip strength: Bridges, bird-dogs, modified side planks, and squats or wall sits build the muscular capacity needed for lifting, carrying, and other daily tasks.
Aerobic conditioning: Walking, cycling, swimming, or another tolerated activity can improve endurance, general health, and confidence with movement.
Functional training: Gradually practising bending, lifting, carrying, pushing, and pulling prepares the body for real-world demands.
These are examples, not a universal prescription. Exercises should begin at a manageable level and progress as strength, control, and tolerance improve. Mild muscular effort is expected, but sharp pain, increasing radiating symptoms, new numbness, or weakness should prompt reassessment.
The goal is not to protect the spine from every load. It is to build a spine and body that can tolerate more.
Our Approach to Degenerative Disc Disease
Degenerative changes on an X-ray or MRI do not determine how much pain you will experience or what you will be able to do. Our approach focuses on the person behind the scan, identifying the factors that may be contributing to pain, restricted movement, and reduced function.
Care may include:
A thorough assessment: We examine movement, strength, neurological function, relevant joints and soft tissues, daily demands, and other possible sources of symptoms. Imaging is considered alongside these findings rather than interpreted in isolation.
Individualized manual therapy: Motion Specific Release (MSR) procedures may be used to address relevant joint and soft-tissue restrictions, reduce pain, and improve comfortable movement.
Progressive exercise: Exercise is tailored to build mobility, strength, endurance, and the capacity required for work, recreation, and everyday life.
Education and self-management: Understanding the diagnosis can reduce unnecessary fear and help people return to meaningful activity with greater confidence.
Regular reassessment: Progress is measured through changes in symptoms, movement, neurological findings, and function. The plan is adjusted or further evaluation is recommended when recovery does not follow the expected course.
Developed by Dr. Brian Abelson, DC, MSR draws on more than 30 years of clinical experience in musculoskeletal care. It integrates clinical reasoning, manual therapy, functional exercise, and collaboration with other healthcare professionals when appropriate.
The objective is not to erase every age-related change from the spine. It is to reduce pain, restore function, and help each person build the capacity to move forward with confidence.
References
Battié, M. C., Videman, T., & Parent, E. (2004). Lumbar disc degeneration: Epidemiology and genetic influences. Spine, 29(23), 2679–2690.
Bogduk, N. (2005). Clinical Anatomy of the Lumbar Spine and Sacrum (4th ed.). Elsevier Churchill Livingstone.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816.
Brox, J. I., Sørensen, R., Friis, A., Nygaard, Ø., Indahl, A., Keller, A., Ingebrigtsen, T., Eriksen, H. R., Holm, I., Koller, A. K., Riise, R., & Reikerås, O. (2003). Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine, 28(17), 1913–1921.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., & Maher, C. G. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383.
Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., & Underwood, M. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367.
Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, (9), CD009790.
Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736–747.
Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., & Kato, F. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1,211 asymptomatic subjects. Spine, 40(6), 392–398.
Schleip, R., Findley, T. W., Chaitow, L., & Huijing, P. A. (Eds.). (2012). Fascia: The Tensional Network of the Human Body. Elsevier.
Swanson, B. T., & Creighton, D. (2020). The degenerative lumbar disc: Not a disease, but still an important consideration for orthopaedic manual physical therapy practice. Journal of Manual & Manipulative Therapy, 28(4), 191–200.
Wong, A. Y. L., Karppinen, J., & Samartzis, D. (2017). Low back pain in older adults: Risk factors, management options and future directions. Scoliosis and Spinal Disorders, 12, 14.
Disclaimer:
The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
Viewing or using this content does not establish a practitioner-patient relationship. If you have questions about a medical condition or symptoms that are new, severe, or worsening, consult an appropriately qualified healthcare provider.
MSR is not responsible for decisions made or actions taken solely on the basis of this educational content. For complete information about website use, third-party links, privacy, and legal terms, please review the MSR Terms of Use, Privacy Policy, and full website disclaimer.
DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
Continue Learning with MSR Courses and MSR Pro
For Healthcare Practitioners
Motion Specific Release integrates assessment, clinical reasoning, manual therapy, exercise, and patient education within one adaptable approach to musculoskeletal care.
MSR Pro and MSR courses support different parts of that learning process:
Structured Clinical Education: MSR courses connect applied anatomy and biomechanics with orthopedic and neurological assessment, myofascial procedures, fascial expansions, joint mobilization, manipulation, and rehabilitation.
Hands-On Skill Development: Live training provides opportunities to refine palpation, patient positioning, force application, and clinical decision-making through practice and direct feedback.
MSR Pro Clinical Library: Members receive access to more than 200 MSR procedures, downloadable and fillable clinical forms, examination resources, rehabilitation progressions, and exercise-prescription materials.
Extensive Video Resources: More than 800 videos support examination, treatment procedures, exercise rehabilitation, and clinical application.
Patient Education: A library of 50 condition articles helps practitioners explain common musculoskeletal problems and provide patients with practical information.
Continued Development: Resources are updated as MSR courses and clinical education continue to evolve.
Videos and articles can introduce concepts, but hands-on proficiency develops through deliberate practice, feedback, and experience. MSR is designed to help practitioners connect technique with clinical reasoning and adapt care to the individual rather than apply the same protocol to everyone.
Explore MSR Pro | View Online and Live Courses
Comments