Many individuals with back pain of mechanical nature will often present to their Family Physician’s office, walk-in clinic or an urgent care centre. These individuals are often treated with first line anti-inflammatories/pain medication as well as an X-ray or MRI studies. These are great tools and have provided significant improvement in many diagnostic features of health care. However, these tools are still often over used as a diagnostic tool for neck and back pain.
A common term or diagnosis that is heard following the results of the x-ray/MRI is “degenerative disc disease” (DDD). To keep this post as simple as I can without going into a lecture of the proper use of medical language, people will see the word “disease” and automatically think that there is something inherently wrong with their spine and that it no longer works properly. This is quite common. Now add the fact that likely no one has described to them their findings or what this term means, it’s no wonder people tend to stop moving afterwards. We hear things constantly like “ I can’t do –insert blank statement--because I have degeneration in my spine.”
What people need to understand is that according to recent research by Brinjikji et al. 2015., degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain (1). The prevalence of disc degeneration in asymptomatic (without any pain) individuals increased from 37% of 20-year-old individuals to 96% of 80-year olds (1). What is important here, is that many imaging-based degenerative features are likely part of normal again and unassociated with pain (1). It is very important that these results be interpreted in the context of the patient’s clinical condition. So instead of worrying about the label that is put on your imaging results, what you shoulder focus on is the function that you possess. Function is key.
To summarize as Dr. Stu McGill says, “Saying to someone that they have degenerative disc disease, is like telling an elderly person with wrinkles on their face they have degenerative face disease.”
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015 Apr 1;36(4):811-6.