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.
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?
['Swanson|Brian T|BT|0000-0002-7146-4537', 'Creighton|Douglas|D|']
D001696:Biomechanical Phenomena D049673:History, 20th Century D049674:History, 21st Century D006801:Humans D055959:Intervertebral Disc Degeneration D017116:Low Back Pain D026201:Musculoskeletal Manipulations
review Degenerative disc physiology biomechanics low back pain imaging clinical reasoning manipulation