Degenerative Disc disease (DDD) is a long-term condition that develops over many years, it is characterised by a reduction in disc height and a reactive change of the joint line. As seen in the picture below. To be clear here, everybody will have degenerative changes at some point in their lives. Recent evidence is showing that from as early as 21 people can have what would be termed degenerative changes on X-ray or MRI (now just because this is “normal” does not make it optimal but that’s a post for a later date) without any pain what so ever. Pain from degenerative changes is only termed DDD when it starts to cause pain.
Although degeneration can be present from a young age, 90% of those with DDD are 65+ this is due a lifetime of mechanical “wear and tear” on the discs and joints but also from around 50 years of age there are collagen changes (the substance that makes up your connective tissues) that result in the tensile strength of the collagen diminishing. Females tend to suffer more than men likely due to hormonal differences, but their may also be a genetic component.
The symptoms of Degenerative Disc Disease are: -
- Pain in the lumbar or buttock region, sometimes referring down towards the knee
- Pain often comes and goes and can range from a nagging ache to sharp and severe.
- Pain can last for days to months
- Aggravated by sitting for long periods
- Relieved with general movement especially walking
- Bending is often a problem and can aggravate symptoms
- Lying down can also relieve pain
Many people especially runners experience pain down the front of the shin and have either self diagnosed or been to their GP who have given them the diagnosis of "shin splints".
So what exactly is shin splints? many medical professionals use the term shin splints as an umbrella term for pain down the front of the shin either due to lack of real understanding or perhaps just simple misdiagnosis.
This mis understanding is not the fault of the medical professional, but rather because of the vague definition given to shin splints and so shin splints has been used as more of an umbrella term rather than defining it as the specific condition it is. The American Medical Association of Nomenclature of Athletic Injuries state that the term shin splints should be confided to conditions of musculoskeletal origin, However this definition would mean that conditions such as tibial stress fractures, chronic exertional compartment syndrome, Tibialis Anterior strain etc are all put under this umbrella term. Krenner, 2002 on the other hand describes shin splints as micro tears in either the origin or insertion of the tibialis musculature which may also include interosseous membrane pain and tendonitis alongside periostitis, which I believe is a far better and more specific definition.
So how do you know if you have shin splints or Chronic Exertional Compartment Syndrome (CECS). People with CECS can go months if not years before they are properly diagnosed, as some of the symptoms are similar to shin splints i.e. pain usually starts in the front of the shin. However, there are a few other symptoms that will differentiate CECS. First of all pain usually starts at a predictable distance into a run and will gradually get worse the further you try and run. Second, numbness and pins and needles will start to develop if you continue to push through the pain to the point where your entire shin and foot will go completely numb. Stopping will usually relieve the symptoms. Please note: If you experience these symptoms and stopping the activity does not relieve your symptoms within a few minutes then you should seek immediate medical attention.
The rotator cuff is a group of four muscles the supraspinatus, infraspinatus, subscapularis and the Teres minor muscle. These muscles work synergistically to stabilise the humerus in the glenoid or your shoulder joint making sure that the humerus glides perfectly within the joint and preventing the humerus from compressing the structures around the joint. The muscles of the rotator cuff also act as synergists to the bigger surrounding muscles. Unfortunately these muscles are neglected and are rarely exercised well enough or at all by most active individuals. Therefore they become weak and unable to check the force generated by the much larger chest and back muscles leading to dysfunction and later to injury.
Rotator cuff tears (RCT) are a fairly common orthopaedic complaint. Typically people who suffer a RCT are usually from two different camps. First is the degenerative RCT typically affecting people of 60+ years old and the second camp are usually athletes or sports enthusiasts who play racquet sports and especially throwing sports such javelin, water polo and rugby. The causes of a RCT vary from person to person however, for those who are playing sports the cause is usually traumatic or overuse with inadequate conditioning of the shoulder complex. However for the degenerative RCT there are several intrinsic and extrinsic causes.
Intrinsic and Extrinsic Factors
The most widely excepted factor for RCT's is chronic overuse of the rotator cuff that leads to micro-tears within the tendons that overtime build up to cause a rupture of the tendon (usually the supraspinatus). Some researchers believe that degeneration of the rotator cuff is a normal and natural part of ageing. A study back in 1991 found that 97% of 891 tendons examined had signs of degeneration. This would certainly support the ageing theory. However, just because something is normal does not make it optimal. As their is no research that has investigated our modern lifestyles effect on degenerative RCT. In other words how does our lack of exercise, high stress jobs, poor food quailty etc have on our bodies ability to heal itself and prevent things like RCT's. Whilst there are no studies that factor in all the various variables as it would be impossible to quite frankly. There are studies available that single out certain lifestyle choice, such as smoking as well as looking at diabetes and high cholesterol (Essentially the effect of a poor diet/lifestyle) and the increased incidence of RCT. I will link to those papers at the end of this blog.
Andy has been involved in the health & fitness industry for over 10 years, specialising in corrective exercise, injury prevention and rehabilitation of low back, neck and shoulder pain. He also has an interest in the use of Osteopathy for the management of headaches.