Disc degeneration – A Dirty Word?

Recently I was asked by a General Practitioner what my opinion is regarding early investigation with MRI, CT and X-ray scans and my response would probably shock many Exercise Physiologists… I responded that, “Yes, they CAN be a good tool and that they MAY help reduce the impact of an injury on a patient BUT…”. This part of my sentence may offend many allied health professionals, what comes after the all-important ‘but’ was my real point, which is “the need for patient understanding of the results is paramount to their usefulness. If a patient does not come out of an appointment with a thorough knowledge of what degeneration is and what it means, or any other findings that are highlighted and normalised, then scans of any kind are more than likely to inhibit treatment in the long run”.

When an individual is confronted with scan results that say anything other than normal, they assume that a bulging disc or flagged degeneration is the cause of their pain. A study of 1,211 individuals revealed that 87% of the cohort had a bulging disc although they were asymptomatic. In comparison a similar study into a cohort of 3,110 with no pain or other symptoms revealed that 37% of individuals under 20 years of age showed some disc degeneration, and 96% of individuals under the age of 90 had some form of degeneration with no signs or symptoms. These results have been shown repeatedly in shoulder, hip and ankle pathologies so how does a scan help? It can and should be used to help normalise, eliminate and reduce stress. Therefore, if a patient leaves an appointment without knowing what degeneration means and goes home worried that they are about to fall apart, or degeneration is going to collapse their spine, then a scan should not be conducted.

In reality as an Exercise Physiologist we will treat the symptoms, and as a clinician my goal is to help my client understand their body and the results that they have been provided. BUT…. If a patient comes into my care with a mindset of I have a bulging disc and that’s the cause of my pain, or my spine is degenerated, so I must be careful how I move then there is a large barrier to treatment. Over the last decade there has been a rise in the availabilities of MRI and CT scans, although the community is only just catching up with the data that imply disc degeneration is not a dirty word.

At Absolute Balance we take pride in the time we allocate to our patients to educate them, demystifying diagnostic terminology and the time we spend to involve our clients with their treatment plans. A patient centred approach that takes in biopsychosocial factors, and education for the individual is a proven way of generating positive results. If you have had any scans be sure to ask your GP or allied health professional to take the time to explain the results with you, if you are concerned, raise that concern! A scan for back pain should be used as a tool to eliminate or highlight movements that should be avoided, not a tool that will make you scared of moving. If you have any concerns, come in for your free initial assessment with the Accredited Exercise Physiologists at Absolute Balance today!

Jordan M Woods

(B.Sc. Exercise, Sport Science, and Rehabilitation, GradDipSc.

Exercise Physiology Rehabilitation)

 

References

Culvenor, A., Øiestad, B., Hart, H., Stefanik, J., Guermazi, A., & Crossley, K. (2018). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal Of Sports Medicine, bjsports-2018-099257. doi: 10.1136/bjsports-2018-099257

Frank, J., Harris, J., Erickson, B., Slikker, W., Bush-Joseph, C., Salata, M., & Nho, S. (2015). Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy: The Journal Of Arthroscopic & Related Surgery31(6), 1199-1204. doi: 10.1016/j.arthro.2014.11.042

Girish, G., Lobo, L., Jacobson, J., Morag, Y., Miller, B., & Jamadar, D. (2011). Ultrasound of the Shoulder: Asymptomatic Findings in Men. American Journal Of Roentgenology197(4), W713-W719. doi: 10.2214/ajr.11.6971

Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., & Kato, F. (2015). Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1211 Asymptomatic Subjects. Spine40(6), 392-398. doi: 10.1097/brs.0000000000000775

Schmidt, C. (2017). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Manuelletherapie21(02), 54-55. doi: 10.1055/s-0043-105930