John Seivert: Is degenerative disc disease a disease?
The short and quick answer, no! However, it is going to take a lot of training of all the medical professionals to change the language. I was first introduced to the fact that discs to not deteriorate as we once thought while I was in postgraduate school in Perth, Western Australia in 1990. My professor , Dr. Lance Twomey, who is the author of over 100 peer reviewed studies and co-author of books on human anatomy, was showing the class the normal age-related changes of the lumbar discs. I was fascinated to see the cadaver dissections of the lumbar spine throughout the decades of life. Seeing the human anatomy up close and having medical records of these patients was fascinating. Many of the patients had no history of back pain, but their spines looked very “old.” The discs were in a lot of different shapes. Kind of like our bodies on the outside. If we have wrinkles on the outside we probably have wrinkles on the inside. This insight has allowed me to help patients understand the vast array of spinal alignments and the normalcy of it all.
For years I have been explaining to my patients with low back pain that they do not have a serious problem or disease in their back. These are patients that have had X-rays taken of their low backs with descriptors in the report stating that they have multi-level degenerative disc disease (DDD). This information given to the patient without explanation can cause a great deal of fear, anxiety and disability. The research has shown that the more imaging patients receive for their musculoskeletal pains, the more dysfunction and disability is created. A medical doctor is using imaging studies to rule out serious pathology. However, the majority of patients that receive imaging studies do not get a consultation to explain to them that for many people, the degenerative disc disease in the spine is a normal aging process. A study done in 2010 by Dr. Webster and his associated demonstrated that radiological imaging for low back pain results in poorer health outcomes, poor perceived prognosis, and patients were more likely to have surgery. With the current state of rehab medicine making strides in helping patients heal with accurate information about the interpretation, several organizations have adopted a stance on what we call degenerative disc disease (DDD).
The American Academy of Orthopedic Manual Physical Therapists (AAOMPT) has issued a position statement on Oct. 25, 2019. AAOMPT position statement to opposing the use of Degenerative Disc Disease as a diagnostic term.
The position statement further explains, Degenerative Disc Disease (DDD) is a commonly used term to diagnose an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column changes shape and size. These changes are a normal process of aging and not linked to a disease. The use of the term “disease” in the diagnosis is not in the patient’s best interest because it misinforms patients, may lead to unnecessary treatment and can worsen the prognosis.
What I have found in my practice is that patients react very poorly to the words “degenerative disc disease.” They lose hope and feel that there is nothing they can do if their spine is deteriorating. It usually takes me a session or two to get my patients to understand that they are not damaged, worn out, and destined for a wheelchair. Through careful movements and progression of exercises with less passive treatments as the visits go on, patients can see that the label of DDD is just healthy aging of the spine. I have heard on several occasions over the years, “I wish I would have never gotten that MRI of my spine because I keep thinking of those crushed discs, and even though I know it is a normal part of aging, I can’t help but feel a bit vulnerable.”
Lastly, I want to share with you a patient scenario that occurred in the summer of 2018 that hit home. My patient, Jon (not his real name) is a 62-year-old construction worker who hurt his back at work. He fell from a scaffolding and had pretty significant pain in his back. He went to see his doctor the next day because he did not want to go to the emergency department. He knew he was not in any serious problem because he could move all his toes and legs normally and had normal sensation in his legs as well as he had normal bowel and bladder function. When he saw the doctor, he told him he did not want to have an X-ray or an MRI but just wanted to go to PT. This is what he said to his doctor, “Doc, I have been doing construction for 40 years, and I know my back looks like &%$%, so can I just go to PT and forget about the pictures because I do not want those pictures to make me feel worse.” This guy knew the power of those imaging studies, and he did not want to see his back with what he knew was extensive age-related changes. He did not want to be biased towards thinking he was damaged goods. I applauded him for that, and we progressed quickly in PT. Jon is still doing construction, skiing and taking care of his ranch.
John Seivert is a doctor of physical therapy and he has been practicing for 34 years. He opened Body Logic Physical Therapy in Grass Valley in 2001. He has been educating physical therapists since 1986. Contact him at firstname.lastname@example.org.
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