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

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