Lumbar disc degeneration is exceptionally common, affecting up to16% of 20-year olds with an age-related progression to involve 80% of patients over age 40 and 98% of those over 70. (1-3) Check out this new 3-minute video where Dr. Bertelsman examines an actual disc and illustrates the progression of this “degenerative cascade”.
In addition to mechanical factors, a strong genetic influence has been identified which may be responsible for up to 50% of the variability of lumbar osteoarthritis. (4,5)
The clinical presentation of lumbar spondylosis is variable and inconsistent. Radiographic studies have demonstrated that a group of men with very similar radiographic findings of degeneration demonstrated differing clinical presentations, ranging from asymptomatic to severe pain. (6) Most authors believe that the symptoms associated with osteoarthritis result from the predisposing factors and consequences of the process rather than the disease itself. (7)
Imaging studies indicate that degenerative changes (and disc lesions) are more prevalent in symptomatic populations. (8) However, radiographs frequently demonstrate degenerative changes in asymptomatic adults. The presence of osteophytes and the degree of radiographic change does not correlate with symptom severity. (6, 9,10)
While studies evaluating the value of SMT for spondylosis are sparse, spinal manipulation has proven beneficial in the treatment of chronic lower back pain. (11-13) Furthermore, joint dysfunction is a primary risk factor for the development & progression of degeneration. (14) Manipulation restores joint function. (15) Manipulation is an “important component to reduce the progression of chronic DJD and pain”. (16) At least one study demonstrated that spinal manipulation decreases pain and improves mobility in patients with degenerative change. (17)
Clinicians should exercise good clinical judgment to determine when lumbar manipulation may be contraindicated. The value of high velocity, low amplitude spinal manipulation has an inverse beneficial relationship to the progression of lumbar degeneration. Despite the fact that patients with biomechanical joint dysfunction from early spondylosis may benefit tremendously from spinal manipulation, the presence of severe degeneration is a contraindication to HVLA manipulation. Low force manipulation and flexion-distraction are useful options. Flexion-distraction has shown similar benefit to HVLA in patients with subacute and chronic LBP. (18)
Clinicians should focus efforts on maximizing function as rapidly as possible. Implementation of an exercise program has been shown to help back pain patients. (19,20) Home programs should focus on stretching of hypertonic lumbar and hip musculature as well as strengthening the hip and core stabilizers. (21)
Not sure exactly which exercises to prescribe? No worries… ChiroUp has scoured the latest research to develop “best practice” protocols for Lumbar Spondylosis and 90 other conditions. Plus, in about 20 seconds, you can customize and prescribe the most appropriate exercises, including video demonstrations and ADL advice. Want to learn more? Click here to try it today.
- Lawrence JS. Disc degeneration. Its frequency and relationship to symptoms. Ann Rheum Dis. 1969;28:121–38.
- Symmons DPM, Hemert AM, Vandenbrouke JP, et al. A longitudinal study of back pain and radiological changes in the lumbar spines of middle aged women: radiographic findings. Ann Rheum Dis. 1991;50:162–6.
- Miller JA, Schmatz C, Schultz AB. Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine. 1988;13:173–8.
- Spector TD, MacGregor AJ. Risk factors for osteoarthritis: genetics. Osteoarthritis Cartilage. 2004;12(Suppl A):S39–44
- Battie MC, Videman T, Gibbons LE, Fisher LD, Manninen H, Gill K. 1995 Volvo Award in clinical sciences: determinants of lumbar disc degeneration—a study relating lifetime exposures and magnetic resonance imaging findings in identical twins. Spine 1995; 20: 2601–2612.
- Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69–73.
- Modic, MT, Ross JS. Lumbar Degenerative Disk Disease. RSNA Radiology October 2007, Volume 245, Issue 1
- Brinjikji W, Diehn FE, Jarvik JG, et al. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Amer J Neuroradiology 2015 Dec;36(12):2394-9.
- Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Spine. 2005;20:2312–20
- O’Neill TW, McCloskey EV, Kanis JA, et al. The distribution, determinants, and clinical correlates of vertebral osteophytosis: a population based survey. J Rheumatol. 1999;26:842–8.
11.. Tulder MW, Koes B, Malmivaara Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J. 2006;15(1):S64–81.
- Bromfort G, Haas M, Evans RL, et al. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine. 2004;4(3):335–56.
- Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. Ann Intern Med. 2017;166(7):514-530.
- Roos EM, Herzog W, Block JA, et al. Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nat Rev Rheumatol. 2011;7:57–63.
- Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002;2:357–71.
- Srbely J. Spinal manipulative therapy and its role in the prevention, treatment and management of chronic pain J Can Chiropr Assoc. 2012 March; 56(1): 5–7.
- Vieira-Pellenz F, Oliva-Pascual-Vaca A, Rodriguez-Blanco C, Heredia-Rizo AM, Ricard F, Almazán-Campos G. Short-Term Effect of Spinal Manipulation on Pain Perception, Spinal Mobility, and Full Height Recovery in Male Subjects with Degenerative Disc Disease: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2014 May 23.
- Stern SD, Cifu AS, Altkorn D. From Symptom to Diagnosis, McGraw Hill NY. 2006
- Hayden JA, Tulder MW, Malmivaara AV, et al. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142:765–75.
- Mitchell RI, Carmen GM: Results of a multicenter trial using an intensive active exercise program for the treatment of acute soft tissue and back injuries. Spine, 1990;15:514-521
- Standaert CJ, Weinstein WM, Rumpeltes J, Evidence-informed management of chronic low back pain with lumbar stabilization exercises The Spine Journal 8 (2008) 114–120
About the Author
Dr. Tim Bertelsman
DC, CCSP, DACO
Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.
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