Discogenic pain is controversial–or is it?
Low back pain is common, really common, and responsible for the second most common reason why people visit their doctors. And yet, it still continues to elude scientists of its specific origin.
One convincing theme in low back pain are findings associated with the intervertebral discs. Often it is first recognized with reduced disc height on x-ray and then if persistent, followed up with MRI demonstrating the same but with evidence of hypointesity in a T2 weighted MRI. Most researchers agree that this finding indicates a reduction in water and proteoglycan content.
Since the development of upright MRI, we are now able to see the spine under load and motion. This has provided us a window into the dynamic movement of the vertebrae and the discs in between them–showing spondylolisthesis in flexion and retrolisthesis in extension.
Some believe the only way to discern whether the disc itself is the painful anatomical structure, is to do a discogram. This is a procedure that punctures the disc with a needle and over pressurizes it to see if it is painful to the patient. This is kind of like over inflating a bicycle tire. The problem with this procedure is we know when a disc is punctured, it facilitates the degeneration process.
Discogenic pain is often a deep kind of pain because it is an anterior structure and heavily innervated. It is often relieved by lying down and worse with sitting. It is also known to get sore after a long period of recumbency–like after a nights rest.
Dynamic Disc Designs enables the practiotioner to explain the inner workings of the disc. When patients understand flexion load stresses the posterior annulus, they quickly get motivated to maintain their lordosis with bending and lifting. This modification behaviour improves outcomes with spine.
Discogenic pain is for real. We are learning more and more about how the discs are at the core of low back pain.