What “degeneration” in a scan report really means
With age, the intervertebral discs lose water and height, bony outgrowths (osteophytes) appear at the edges of the vertebral bodies, and the facet joints thicken. It is a process similar to hair going grey – it affects most of us, and it shows up on imaging in people without any symptoms too. That is why the phrase “degenerative changes of the spine” in an X-ray report does not, on its own, explain where your pain comes from. In some people uneven wear of the discs and joints also leads to a sideways curve of the spine – we write about this on the adult scoliosis page.
The degree of change on the image correlates poorly with how bad the pain is. Someone with “advanced degeneration” may manage without any problem, while someone with minor changes may suffer a great deal. Pain is largely influenced by your activity level, muscle strength, sleep, stress and how long you stay stuck in one position. That is good news, because you can genuinely influence most of these factors.
Spinal stenosis – when the legs hurt
Sometimes degenerative changes narrow the spinal canal or the openings through which the nerve roots exit. The typical symptom is neurogenic claudication: after a few minutes of walking or standing the legs become heavy, go numb or hurt, and relief comes when you sit down or lean forwards – for example leaning on a trolley in a shop. Reduced blood supply to the legs in vascular disease produces similar symptoms, with the difference that then it is usually enough just to stop, without changing position. Telling these situations apart can be a job for a doctor.
With stenosis, exercises in slightly flexed positions, a stationary bike and gradually longer walks work well. If, however, leg weakness is increasing and your walking distance is shrinking quickly, you need an assessment by an orthopaedic surgeon or a neurosurgeon. Acute nerve root pain in younger people usually has a different cause – we describe it on the page about lumbar disc herniation.
Movement as the foundation of treatment
Current guidelines on chronic spinal pain agree: the foundation is exercise and staying active, while passive treatments – manual therapy or massage – are an add-on that makes it easier to get started. There is no single “best” set of exercises. The effective one is the one that is well chosen, graded and done regularly.
In practice we combine strength training for the trunk, hips and legs with mobility, balance and endurance exercises. In medical training you learn the technique under a physiotherapist’s supervision so that you can later exercise on your own. The first effects – less stiffness, getting out of bed more easily – usually appear after a few weeks, while the full effect of strength training takes two to three months.
When to come in and what to expect
The most common mistake we see is giving up movement “to protect the spine”. Avoiding bending, lifting or walks weakens the muscles and lowers your tolerance to load, so over time it starts hurting sooner and sooner. Sensibly dosed movement does not speed up degenerative changes – a lack of movement, on the other hand, clearly makes everyday function worse.
It is worth getting in touch when the pain limits your everyday activities, keeps coming back, or when reading your scan report has made you afraid to move. At the first visit we explain what the changes in your result mean, check what is actually causing the symptoms, and start treatment straight away. If the problem mainly affects your neck, you can read more on the page about neck pain. You can arrange an appointment via the Contact page.