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Review
. 2020 Sep;28(4):191-200.
doi: 10.1080/10669817.2020.1758520. Epub 2020 May 4.

The degenerative lumbar disc: not a disease, but still an important consideration for OMPT practice: a review of the history and science of discogenic instability

Brian T Swanson  1 , Douglas Creighton  2
Affiliations
Review

The degenerative lumbar disc: not a disease, but still an important consideration for OMPT practice: a review of the history and science of discogenic instability

Brian T Swanson et al. J Man Manip Ther. 2020 Sep.

Abstract

Background: A recent AAOMPT position paper was published that opposed the use of the term 'degenerative disc disease' (DDD), in large part because it appears to be a common age-related finding. While common, there are significant physiologic and biomechanical changes that occur as a result of discogenic degeneration, which are relevant to consider during the practice of manual therapy.

Methods: A narrative review provides an overview of these considerations, including a historical perspective of discogenic instability, the role of the disc as a pain generator, the basic science of a combined biomechanical and physiologic cycle of degeneration and subsequent discogenic instability, the influence of rotation on the degenerative segment, the implications of these factors for manual therapy practice, and a perspective on an evidence-based treatment approach to patients with concurrent low back pain and discogenic degeneration.

Conclusions: As we consider the role of imaging findings such as DDD, we pose the following question: Do our manual interventions reflect the scientifically proven biomechanical aspects of DDD, or have we chosen to ignore the helpful science as we discard the harmful diagnostic label?

Keywords: Degenerative disc; biomechanics; clinical reasoning; imaging; low back pain; manipulation; physiology; review.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

References

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