History & Science of Lumbar Discogenic Instability
- RRS Education
How disc degeneration contributes to spinal pain is certainly of interest to chiropractors and all other clinicians who deal with musculoskeletal conditions. Also of critical importance is the language we use with our patients relating to their condition and diagnosis.
The American Academy of Orthopedic Manual Physical Therapists (AAOMPT) recently released a position statement stating “[the] AAOMPT supports and encourages early physical therapy interventions with known effectiveness instead of high-risk procedures and medication, and strongly recommends that clinicians avoid using the diagnosis of degenerative disc disease”. This objection is based on several factors, specifically: 1) degenerative disc disease (DDD) is a common age-related observation and therefore not a disease; and 2) clinicians tend to over-utilize diagnostic imaging to direct treatment, which is in conflict with the evidence.
However, the authors of this paper suggest that imaging findings can and should inform treatment decisions as one aspect of a broad clinical reasoning process. Past research and editorials/commentaries have suggested that disc degeneration is a common finding in adults and that “the choice of treatment doesn’t seem to matter as much as identifying an individual likely to respond”. Despite this, the International Society for the Study of The Lumbar Spine references DDD as the most common cause of low back pain. Pain arising from DDD has been suggested to result from the hallmarks of the degenerative process, such as tears of the annulus fibrosis, loss of disc height, alterations in loading and stability of the motion segment, and accompanying biochemical changes.
This narrative review aims to understand if the manual interventions used in clinical practice reflect the scientific evidence pertaining to the biomechanical aspects of DDD leading to pain, or whether the science has been ignored as the call grows to discard harmful diagnostic labels.
THIS WEEK'S RESEARCH REVIEW: “History & Science of Lumbar Discogenic Instability”
This paper was published in the Journal of Manual &Manipulative Therapy (2020) and this Review is posted in Recent Reviews, Lumbar Spine - Disc & Neurological and the 2020 Archive.