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The Truth About “Degenerative Disc Disease”

The Truth about “Degenerative Disc Disease”

 

What studies have shown on the topic of “disc degeneration” and it’s role in back pain might surprise you. In the medical community, it may be easy to look at changes on imaging and use them to justify why pain is occurring in people of all ages; however, research has been challenging this heavily. Specifically “disc degeneration” was a topic that was covered on the Ice Physio Podcast, which I highly recommend by the way. They interviewed the president of AAOMPT during one of their sessions, and it was a great reminder of the positive direction that the field of Physical Therapy is moving.

 

Did you know that The American Academy of Orthopedic Manual Physical Therapy (AAOMPT) has made a position statement to discourage the use of the term “degenerative disc disease” as a cause or diagnosis for neck or low back pain?

 

President Dr. Elaine Lonnemann stated, “Despite its name, it is not a disease; it’s a natural occurrence that comes with aging. We know that normal changes take place in the discs in our spine as we get older, and these changes or these conditions really shouldn’t be considered degenerative.”

 

What’s the big deal? Aren’t these just words?

 

The reality is that words really do matter. Words have the power to generate feelings of optimism or feelings of doubt. They can encourage confidence to move, or drive fear that can ultimately increase the pain experience. The challenge with this particular example, is that it can drive patients (and often clinicians) to pursue a more aggressive treatment approach (such as surgery) to fix what they feel like will only continue to degenerate/worsen.

 

Not only that, people deserve the right to be educated on options that can be utilized to manage or improve their symptoms based on available research. While I will not argue that structural changes can cause pain and become symptomatic, I would like to challenge all healthcare providers to embrace the idea that often times pain is a much more complicated experience than that. Very rarely is one tissue implicated alone, and just because changes occur over time, this does not guarantee an increase in pain, or ensure further problems with pain in the future. 

 

The reality is, about 90% of the population will experience back pain at some point, and often it can get better through a number of conservative means, and occasionally simply through giving it time and working around the pain drivers. 

 

We need to be careful to use imaging as a way to assign back pain to a specific tissue because people who do and don’t have back pain may find disc changes or even herniations present on imaging. The last time I had read through things, the number of people showing disc herniations on imaging without pain was around 35-40% (at L5-S1 level).

 

Some things to consider:

  • Disc generation is frequently found on imaging even when individuals don’t have pain. 
  • When imaging a group of 20 year olds without back pain, 37% will show age related disc changes. 
  • When imaging a group of 80 year olds without back pain, 96% will show age related disc changes.
  • If these findings were directly correlated with pain, you’d expect back pain to increase after the age of 80; however, this usually decreases in occurrence in the 70’s.

 

With that being said, if clinical symptoms and presentation all lead towards a specific diagnosis, and imaging supports this as well, imaging can still be a great option to further pursue answers to decrease pain and return people to function. This is not a charge to throw out the x-ray and MRI machines entirely, just a call to challenge deeper thinking and present some of the research that has been popping up over the last decade in favor of conservative management, our body’s ability to heal, and the importance of understanding that pain is a very complicated experience.

 

If you have been diagnosed with “degenerative disc disease” and have felt helpless, we’d love to chat with you about it. There is hope that you are not destined for a life of decline in function and pain. Often times, with some guided applications of movement, loading, and proper stresses, you can decrease restrictions and make yourself much more resilient for the demands of life.

 

We are passionate about keeping people well informed, because movement is imperative to continued health, longevity, and quality of life. We would love to answer any questions you have, and encourage you to reach out if you’re having trouble functioning to your fullest potential.

 

Tyler Vaughn

PT, DPT, OCS, CSCS, CFL1

Refine PT and Performance 

251-270-1551

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The Truth About Pain

Pain is something that we all will experience at some point in our lives. It is inevitable. But the question is, how will you deal with it? With this question in mind, we want to provide you all with accurate information about what pain is and what pain is not so that you can make an informed decision about your own health!

 

Pain is normal.

 

Pain is actually a normal experience and you may not know it, but you should be thankful you can experience it. Let’s say you are walking barefoot and step on a piece of glass you better hope you can experience pain! If not, it won’t be good news. You see, when your pain system is acting appropriately, it acts similar to an alarm system.

Alarm systems function to protect you and will go off whenever there is a threat. This is a good thing. Our brain produces pain similarly whenever it feels threatened. This allows us to dig deeper and figure out why something may be bothering you. However, there are times when an alarm system can be hypersensitive and go off with no real threat around. This is often the case when people experience persistent pain.

In order to better understand pain being a perception of threat, let me explain further by a common example. Let’s say that you are walking across the street when you twist your ankle. You fall to the ground, and look up to see a truck driving directly towards you. Do you think you would experience pain in that moment? Probably not. You would probably get up and move out of the way to safety on the other side of the street. Now, let’s say you are walking in your house and twist your ankle in the same fashion? Do you think you would experience pain in this situation? Probably so, because it is the biggest threat at the point-in-time. I hope this helps demonstrate that pain is specific to a wide range of inputs and your brain’s interpretation of safety.

 

Pain does NOT equal damage.

 

Time and time again, study after study, we are finding that changes on x-rays, MRIs, and other images have a very poor correlation with pain. Here are a couple of studies supporting these findings.

  • Ultrasound of 411 individuals without pain, 23% of people had a rotator cuff tear. (1)
  • CT scan or MRI of 3110 individuals without pain, 30% of 20 year-olds and 84% of 80 year-olds had a disc bulge. (2)
  • MRI of 5,397 knees in people without pain, 19-43% had arthritis (age greater than 40 years-old) (3)
  • Sham surgeries (performing a procedure with no structural change) were found to be just as effective as surgeries in decreasing pain. (4)

We, as healthcare providers, have historically done a terrible job of providing our patients with this GREAT news. We have instead caused unnecessary fear and hyper-awareness of imaging findings that assume that you are damaged. In actuality, these findings may or may not have anything to do with your current pain experience. It is very important to know that as we age, our bodies change and it’s totally okay and normal! My favorite analogy to understand this concept is that changes on images are like wrinkles on the inside. Just as we know that we develop wrinkles as we age and that they do not correlate with pain, we know that there will be changes on your x-rays and MRIs that are no more than wrinkles on the inside. There are obviously exceptions to this (i.e. when there is a true structural issue causing your knee to give way such as an ACL tear from a one-time incident, etc) but overall, the findings have no direct correlation to your pain experience. Since we now know these normal imaging findings, you can move away from fear of your imaging and truly begin the road to recovery.

 

Rest is usually the enemy.

 

In the past, due to fear of further damage, you may have thought or been told to just take it easy or perhaps rest altogether. Although there are times when relative rest is beneficial (training/modifying around the problem area), total rest is almost never the case. This is not just a recommendation or simply our opinion, this is time and time again supported in the research. Sadly, our healthcare system as a whole has done a very poor job of promoting the continuation of exercise and physical activity. In our upcoming blogs we will discuss ways to continue moving while experiencing pain. We hope that you all will join us in spreading the news that it’s best to keep it moving!

 

Moving Forward

 

As we journey together through our upcoming blogs, we hope that you will feel better equipped to make informed decisions about what is best for your health and fight back against the societal norms. Do your research. Ask further questions. And keep it moving. We are here to help and want to see you live a healthy, fruitful life!

 

Kyle Thibodeaux PT, DPT, OCS, CSCS

Refine PT and Performance

 

 

References

  1. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-9.
  2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-6.
  3. Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268-1278.
  4. Louw A, Diener I, Fernández-de-las-peñas C, Puentedura EJ. Sham Surgery in Orthopedics: A Systematic Review of the Literature. Pain Med. 2016.

 

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