What is a Degenerative Disc Disease?

Well, first and foremost, it is not a disease but a condition that takes place as the person grows older. The transition to late adulthood can cause physical and physiological changes in the body and degenerative disc disease is one of them.

Degenerative Disc disease ICD 10 – M51.36

It is the wear and tear on the spinal disc causing pain secondary to aging.

What causes degenerative disc disease?

The pain caused by degenerative disc disease is attributed to these factors:

Inflammation 

As the cervical disc goes through a degenerative process, the inflammatory protein leaks out causing an inflammatory response to the surrounding structures. It is the one responsible for tenderness at the back and neck, muscle spasm, and muscle tension.

Abnormal micro-motion instability 

The disc provides cushioning and support but as the person grows older, the disc’s outer layer degenerates leading to unnatural motions in the vertebrae. As a result, it causes tension and irritation to the surrounding muscles causing moderate pain that eventually gets severe as time passes by. ^{(1, 2, 3)}

Image 1: An image outlining the difference between a healthy disc and a degenerative disc.
Picture Source: i1.wp.com

Picture 2: A degenerative disc compared with other disc-related conditions.
Photo Source: www.njsms.net

Symptoms

• Pain, especially when performing physical activities that requires bending and twisting of the spine.
• Pain can also be felt when lifting heavy objects
• Muscle spasm
• A feeling of “giving out” secondary to spinal instability
• Sharp, stabbing pain that radiates to the shoulders, arms, and hands.
• In rare instances, the pain can also be felt in the lower extremities, especially the buttocks, hips, and lower leg.
• Pain when sitting or standing for a long period of time ^{(3, 4, 5)}

Diagnosis

1. Medical history taking – the patient’s past medical and surgical history will be reviewed to find out the possible causes of pain, aside from the degeneration of the body. The doctor will assess the type, onset, and severity of pain.
2. Physical examination – The spine and the surrounding structures will be checked for any abnormalities. It is done through palpation and range of motion test.
3. Imaging studies – To confirm the diagnosis of degenerative disc disease, imaging test needs to be performed such as MRI scan. It can detect a herniated disc, fissures in the disc, and disc dehydration. ^{(4, 5, 6)}

Photo 3: A closer look at a disc that underwent a spinal fusion surgery.
Image Source: i.pinimg.com

Image 4: An artificial disc used in artificial disc replacement surgery.
Picture Source: worldonline.media.clients.ellingtoncms.com

Treatment

The focus is on pain management. The doctor will use various treatment modalities to reduce the pain and improve the patient’s mobility. Treatment for patient with degenerative disc disease is categorized into the following:

• Cold Compress – When at home, the pain can be reduced significantly by applying cold compress on the painful part of the spine.
• Hot compress – With the use of a heating pad, the tissues that surround the spine will be relaxed. It also eases muscle tension and spasm. If you don’t have a heating pad, you can use an adhesive wrap and a warm bath, especially before going to bed.
• Medications – The doctor will prescribe pain relievers and anti-inflammatories to significantly reduce the pain and inflammation. For mild to moderate pain, an over the counter pain relievers and anti-inflammatories will do. However, for severe pain, a higher type and dose of drugs are needed which will require doctor’s prescription. Prescription pain medications should be used as per the doctor’s recommendation. Do not use it for a long period of time as it could cause addiction.
• Transcutaneous electrical nerve stimulation (TENS) – It is a device that alleviates pain by sending an electric pulses through the body.
• Manual manipulation – A spine specialist (chiropractor) will manually adjust the spine so as to relieve pain and muscle tension. It removes nerve root pressure thereby relieving the pain and tension.
• Epidural steroid injections – The outer protective layer of the spine is injected with a steroid so as to alleviate the pain. However, epidural steroid injections will only provide temporary relief.

Physical therapy

There are degenerative disc disease exercises that can reduce the pain and prevent its recurrence. These include the following:

• Simple stretching – Stretch the muscles in the spine including the neck, shoulders, and upper back. Stretching the pelvis, hips, and lower back can also improve spinal pain.
• Strengthening exercise – It is done to strengthen the muscles that support the spine. Eventually, it helps reduce pain and tension.
• Aerobic exercise – It improves the circulation of blood and keep the muscles and joints in good shape. For people with severe pain, a low impact aerobic exercise should be performed such as water aerobics and a few minutes in the stationary bike.

Lifestyle modification

A person who is positively diagnosed with a degenerative disc disease should lead a healthy lifestyle. Avoid things that can further compromise your health such as smoking and drinking alcoholic beverages. Make it a habit to perform at least a few minutes of the exercise mentioned above.

You should use ergonomic furniture to prevent pain and avoid further complications.

Surgery

The surgery should be the last resort and it should only be done if all above mentioned strategies fail. Surgical procedures include:

• Spinal fusion – the two adjacent vertebrae are grafted together to eliminate instability and reduce pain to a greater extent. It is done under a general anesthesia.
• Artificial disc replacement surgery – A device is implanted in the spine to act as a natural support to the spinal disc. Just like the spinal fusion surgery, artificial disc replacement surgery is done under general anesthesia. The disc is made from metal or plastic.

Prevention

There is no way to prevent degenerative disc disease because it is a part of the aging process and every person ages with time whether you like it or not. However, with a healthy lifestyle, mild exercise, and nutrition, you can delay the onset of degenerative disc disease. ^{(6, 7, 8, 9, 10)}

What is the prognosis?

People with degenerative disc disease have a good prognosis as long as the above-mentioned practices are followed. Pain management is important but with lifestyle modification, the pain can be reduced to a greater extent.

References:

1. https://www.spine-health.com/conditions/degenerative-disc-disease/what-degenerative-disc-disease
2. https://www.webmd.com/back-pain/degenerative-disk-disease-overview
3. https://www.medicinenet.com/degenerative_disc/article.htm
4. https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/degenerative-disc-disease.html
5. https://en.wikipedia.org/wiki/Degenerative_disc_disease
6. https://www.medicalnewstoday.com/articles/266630.php
7. https://www.laserspineinstitute.com/back_problems/degenerative_disc_disease/
8. https://www.arthritis.org/about-arthritis/types/degenerative-disc-disease/
9. http://columbiaspine.org/condition/degenerative-disc-disease/
10. https://www.mayfieldclinic.com/PE-DDD.htm

What is a Dowager’s Hump?

It is a condition characterized by a formation of a hump on the upper back. It is popularly known as kyphosis. In this condition, the upper back is more than 45 degrees forward. It affects both men and women, although it is more common in women, especially those who are already in their post-menopausal age. ^{(1, 2)}

Dowager’s Hump Pictures

Image 1: A comparison image between a normal spine and someone who has a kyphotic spine/dowager’s hump, hunchback.
Picture Source: drmikesnyder.com

Picture 2: A dowager’s hump is commonly seen on elderly people.
Photo Source: images.theconversation.com

Photo 3: How the shape of the spine changes with age.
Image Source: www.abundanthealthchiro.com

What are the Symptoms?

• Abnormal curvature of the spine
• Muscle fatigue
• Restricted lung movement causing difficulty in breathing
• An abnormal posture and balance problems
• Chronic back and shoulder pain ⁽³⁾
• Loss of appetite
• Loss in height
• Hunch back
• The abdomen bulges
• Hip pain
• Difficulty in sleeping ⁽²⁾

What can increase your risk for Dowager’s hump?

1. If you constantly do movement that requires bending of the waist
2. Bending when lifting
3. Jogging and running
4. High impact aerobics ^{(3, 4)}

Complications

1. Nerve damage
2. Breathing problems
3. Hip fracture
4. Soft tissue inflammation ^{(2, 4)}

Causes

There are various reasons why a Dowager’s hump is formed. The most common causes are as follows:

• Genetic – If you have a genetic abnormality in your spine, then that puts you at risk to having a dowager’s hump. As a matter of fact, some people are born with dowager’s hump. Hence, it is safe to say that a dowager’s hump is somewhat hereditary.
• Poor posture – A dowager’s hump can be developed out of a poor posture. Overstretching the spinal ligaments can actually put stress on your spinal column. The lifestyle that many people have today increases the risk for poor posture. Spending too much time in the digital screen makes the bones adapt to such position. The human head alone is too much for the spine to bear, much more if you have a poor posture. The spine needs to adapt, which causes pressure to the neck and back.
• Compression fractures – If you sustained injury affecting the spinal column, there is a possibility of pressure on the bones leading to deformity.
• Osteoporosis – As you grow old, your bone loses density which makes them weak and prone to bending and fracture. A lack of vitamin D and thyroid-related disorder also put you at risk for osteoporosis.
• Arthritis – The spine collapses because the disc loses fluid. Eventually, it could lead to the development of dowager’s hump. ^{(4, 5, 6, 7)}

How to get rid of Dowager’s hump (Treatment)

Image 4: A correction brace is worn to correct the patient’s posture and reverse the signs and symptoms of kyphosis.
Picture Source: i.ebayimg.com

There is no single treatment for dowager’s hump. It is a multi-disciplinary approach and the goal is to not only treat kyphosis but also to prevent it from happening in the future. The treatment approach includes the following:

Dowager’s hump Exercises

Exercises designed to correct kyphosis should be done for at least three sessions a week.

• Moderate stretching
• Yoga (with some restrictions)
• Progressive weight lifting exercise
• Rope exercise

Brace

An orthosis or brace is commonly used in children with kyphosis. How long the child wears the brace depends on the assessment of the patient’s condition. The goal is to restore lumbar lordosis.

Dowager’s hump Surgery

Surgical procedures for dowager’s hump include vertebroplasty and kyphoplasty. What they do is they restore the vertebra’s height and reduce or totally eliminate the pain.

• Vertebroplasty – it uses a needle to target the affected area.
• Kyphoplasty – a balloon is inserted through a tube and targets the vertebra. ^{(4, 5, 7, 8, 9)}

Can you prevent dowager’s hump?

1. Strengthen your bones by taking vitamin D and vitamin C.
2. Perform exercises that can strengthen the bones such as flexibility and chest exercises.
3. Improve your balance and coordination.
4. Maintain a good posture.
5. Work on your diet. Make sure you are eating a well-balanced meal. ^{(2, 6, 10)}

The psychological aspect of having a dowager’s hump

Well, aside from the pain and discomfort caused by dowager’s hump, it can also affect your psychological well-being. With about 45 degrees protrusion from your back, other people can easily notice it. Even if you conceal it, it will still bulge and it does not look great. Aside from the protrusion at your back, your head arches forward and your neck looks like a vulture. Nobody wants to have that.

As your physical appearance changes, your self-confidence and self-esteem suffer. You will become conscious of your looks and chances are you tend to shy away, especially in a large crowd. Some people even have to dissociate themselves with others out of fear and shame.

Which is why it is important to address the problem as soon as you notice it. If you are born with it, then it should be addressed while you are young. If it is developed through the years because of bad posture and other causes mentioned above, then you need to see your doctor and ask for help.

A dowager’s hump is something that should not be taken for granted. If it has been there for a long period of time without any interventions or management, then eventually, it could affect your physical and emotional well-being. It could lead to other health problems. It gets worse as time passes by. Hence, it is of utmost importance to exert active measures to correct it.

Ditch any bad posture habits. Take good care of your bones by eating a well-balanced meal, drinking milk, and taking supplements that promote bone health. If you notice that there is something wrong with your back, then you need to have yourself checked. It is easy to treat a disease or any health condition if it is diagnosed the earliest time possible. Any forms of delay can further aggravate the condition. ^{(2, 5, 7, 8, 9)}

References:

1. https://www.belmarrahealth.com/dowager-hump-kyphosis/
2. https://healthosphere.com/dowagers-hump-treatment-symptoms-pictures-causes-prevention/
3. https://www.livestrong.com/article/145107-dowagers-hump-causes/
4. https://www.healthline.com/health/hump-behind-the-shoulders
5. https://www.postureresources.com/dowagers-hump-fat-pad-causes-treatment/
6. https://www.drweil.com/health-wellness/body-mind-spirit/bone-joint/cure-for-a-dowagers-hump/
7. https://www.skyflohealth.com/dowagers-hump/
8. https://www.parentgiving.com/elder-care/dump-the-dowagers-hump/
9. https://www.yogauonline.com/yoga-for-osteoporosis/osteoporosis-vertebral-fractures-and-dowagers-hump-role-hyperkyphosis
10. https://theboneclinic.com.au/dowagers-hump/A

Some people have this lip biting habit and believe it or not, they don’t even realize they are doing it. Some people bite lip on a purpose because they feel like they are sexy when they are biting their lips. Well, it isn’t a bad habit at all provided it will not lead to self-destruction. Biting the lips too hard, especially habitually can actually lead to bleeding.

If the habit of biting the lips gets out of control, then it could be an indication that a person is suffering from a condition called BFRB or body-focused repetitive behavior. It is not included in the new edition of the Diagnostic and Statistical Manual of Mental Disorder, but it does belong to other specified obsessive-compulsive related disorders.

Just because you are biting your lips does not mean you have BFRB. It only falls under such category if your behavior causes self-destruction, distresses others, and/or interferes with your ability to function normally. ^{(1, 2, 3, 4)}

Image 1: Lip biting is a sexy thing but not until it causes self-destruction.
Picture Source: www.hypnosisdownloads.com

Picture 2: Swelling and bleeding of the lips secondary to severe and chronic biting.
Photo Source: img.memecdn.com

Why do people bite their lips?

The cause of lip biting is vast. In fact, you could hardly pinpoint the exact cause. However, it is linked with stress and anxiety. There are a few biological predispositions too such as the person’s age, gender, temperament, and environment. Research showed that lip biting is common in people ages 11 to 15. It is also more common in women than men. ^{(4, 5)}

Dental conditions can also be the reasons why some people tend to bite their lips. Some of these dental conditions include the following:

• Misaligned bite
• Temporomandibular joint disorder ^{(4, 5)}

How to stop biting lips?

Treating the lip biting habit is all about making the person realize that he/she is unconsciously doing it. It is quite difficult to address this issue because it is not a disease but a problem itself. Lip biting that causes self-destruction is treated using a variety of treatment modalities such as counseling, relaxation techniques, cognitive behavioral therapy, hypnosis, replacement behavior, and addressing any dental issues such as removal of the protruded tooth, wearing braces, jaw exercises, and surgery when deemed necessary. ^{(5, 6, 7)}

Are there any complications?

• Severe redness of the lips
• Inflammation
• The lips are swollen and sore
• The lips peel because of dryness
• Scarring because of chronic biting of the lips ^{(6, 7)}

Photo 3: Dental problems can lead to lip biting behavior.
Image Source: tonguethrust.com

Image 4: A severely swollen lip due to excessive biting.
Picture Source: knowfacts.org

What can you do to prevent lip biting?

There are different practices that can help prevent lip biting. These include:

• Deep breathing/diaphragmatic breathing – It is a relaxation technique many people use to control their breathing and to relieve stress. If you are under a great deal of stress, you have to take a deep breath rather than resort to biting your lips. Take a slow and controlled breath, breath in through your tummy. It is a simple technique but it does really work.
• Muscle Relaxation – A deep breathing exercise combined with progressive muscle relaxation technique can help a lot in preventing lip biting and other forms of BFRB. To do this technique, you need to tense your muscle one at a time to drain the muscles of energy. Doing so will prevent anxiety as your muscles no longer have the strength to cause anxiety symptoms. Doing this on a regular basis will make you feel more relax and comfortable.
• Competing Response – It is a behavior that enables you to completely eliminate the habit of biting your lips. Instead of biting your lips, you could resort to a healthier option such as touching your lips with your fingers. This stops your urgencies to bite your lips.
• Mindfulness – You need to be mindful or cautious of your actions. Pay attention to what you are doing. Many people are unaware that they are actually biting their lips until such time they feel pain in their lips. There are even instances when the lips bruised and wounded. If you develop the state of mindfulness, then you will be conscious of your action, especially if other people notice your lip biting habit. ^{(7, 8, 9, 10)}

What to keep in mind?

Lip biting and other BFRB has the tendency to recur. Therefore, it is important to be wary of the symptoms and if you feel like your lip biting habit starts to recur, then you need to use the strategies mentioned above. Choose the one that you think works best for you.
Biting the lips is not actually a problem until such time that it causes discomfort and stress not only to you but to other people too. If lip biting becomes harmful to your health and well-being, then you definitely need help. Do not be afraid to consult your doctor. Help is always available and there are health care professionals out there who are more than willing to help you.

References:

1. https://www.healthline.com/health/lip-biting
2. https://www.bustle.com/articles/98188-7-ways-to-stop-biting-your-lips-because-its-not-a-good-habit
3. https://www.calmclinic.com/anxiety/symptoms/lip-biting
4. http://www.uncommonhelp.me/articles/how-to-stop-lip-biting/
5. http://texaspediatricdentistry.com/lip-biting-after-treatment/
6. https://healthosphere.com/lip-biting-symptoms-causes-treatment/
7. https://www.drwinans.com/2017/02/bite-lip-time/
8. https://www.everydayhealth.com/dental-health-specialist/chewing-on-lower-lip.aspx
9. https://www.lovepanky.com/flirting-flings/get-flirty/lip-biting
10. https://www.smlglobal.com/help-your-patients-break-lip-biting-habit