Degenerative Disc Disease (DDD)

Question 1

What is DDD?

Answer 1

Loss of hydration and height of the intervertebral discs associated with aging. The result is pain and instability, in severe cases even radiculopathy.

Question 2

What can cause pain in DDD?

Answer 2

i) circumferential tears in the annulus fibrosis
ii) muscle imbalance/irregular activity due to altered biomechanics
iii) inflammation

Question 3

What are the three phases of DDD?

Answer 3

i) dysfunction: disc starts to degenerate
ii) instability: decreased height changed stresses about the joint
iii) stabilization: fibrotic and osteophytic changes fuse the segment

Question 4

What subjective reports might be present with DDD?

Answer 4

Generalized LBP. ROM restrictions (often except extension).

Question 5

What are two outcome measures for DDD (gold standards for back pain)?

Answer 5

i) Roland-Morris

ii) Oswestry

Question 6

What are 5 key objective tests to help determine the presence of DDD?

Answer 6

i) PPIVMs: reduced segment motion in all directions and hard capsular end feel
ii) ALSR: poor lumbopelvic stability
iii) Prone Instability Test: +ve
iv) Neuro Scan: -ve
v) MMTs: painfree, weak glutes

Question 7

What are two differential diagnoses for DDD and how would you rule them out?

Answer 7

i) Erector Spinae strain: Pain on MMT/RIM, flexion/extension dominant symptoms
ii) Chronic lumbar facet syndrome: pain on extension and rotation, TOP, Kemp’s Quadrant Test: +ve