American Academy of Orthopaedic Manual Physical Therapists Releases Position Statement Opposing Use of ‘Degenerative Disc Disease’ as Diagnostic Term
The position statement released recently by AAOMPT is spot on. Few things are as upsetting to me as a clinician as when a patient presents to my office having been scared by this garbage terminology. Degenerative disc disease (DDD) is not degenerative or a disease.
As Professor Stu McGill, a world renowned spine researcher is oft quoted as having said, “A degenerative disc disease diagnosis is the equivalent of telling your wrinkled mother-in-law that she has degenerative face disease.”
AAOMPT says patients often react to the label ‘degenerative disc disease’ by losing hope and seeking more invasive and higher-risk treatments. They avoid beneficial physical activity for fear that exercise and movement will worsen their condition, possibly leading to chronic pain. The majority of spinal pain is self-limiting and can be managed appropriately without the need for medications or risky procedures such as injections or surgery. For those individuals who do need care, AAOMPT supports and encourages early physical therapy instead of high-risk procedures and medication. AAOMPT strongly recommends that clinicians avoid using the diagnosis of degenerative disc disease.
One of the key interventions a clinician can provide to a back pained patient is education about their condition. Telling someone who has had a diagnostic scan or imaging that they are suffering from a disease such as DDD, when in fact this process is a normal part of aging and not a disease at all, causes harm and creates a nocebo effect.
A nocebo in this case arises from a patient being told they have a disease where in fact no disease is present. This can lead to negative expectations of recovery, fear or avoidance of beneficial activities, and seeking more aggressive and invasive treatments when they are not indicated or necessary.
Unfortunately, use of this terminology is still prevalent. Hopefully that changes as more practitioners are made aware of the negative consequences to patients of using this type of poor diagnostic language.