The diagnosis of cervical degenerative disc disease (DDD) is a normal finding, says Gary Karkuff, PT, Partner and Clinic Director of the Hanover Office of First Choice Rehab. "People can be pain-free with DDD," he says. "It is a diagnostic label based on MRI imaging and the label itself can be disabling." 

"Degenerative disc "disease" is a term used to describe the normal changes in aging spinal discs", adds Karkuff. "It can be part of the normal aging process and if a patient is told that he or she has DDD, it sounds scary and tends to generate apprehension and pain." As a result of age-related degeneration, the lower discs in the cervical spine are in all probability going to lose height in part due to the loading forces upon them. The connective tissues of the intervertebral discs change with aging.

Karkuff notes that by and large, the presence of a disc bulge or herniation on MRI doesn't necessarily mean much.  "An asymptomatic bulging disc can look the same as a symptomatic bulging disc. So the presence on a scan doesn't mean it is relevant," he adds. In a classic study published in the Journal of Bone and Joint Surgery, it is found that approximately 40 percent of asymptomatic individuals aged 40 will have abnormalities on cervical MRI and the percentage raises to nearly 90 percent in those over 60. 

To treat DDD, physical therapists will use a diverse approach to treat pain, treating the signs and symptoms and not the label. Karkuff stresses that there is strong, high-quality evidence for the effectiveness of manual physical therapy and exercise in the management of mechanical neck disorders, both short and long-term results.  He assesses most patients with neck pain using the McKenzie classification system. A combination of manual therapy, therapeutic exercise and home exercise are used to manage most of the DDD cases. 

"The obvious use of labels, such as DDD can be hazardous. It is our job as PTs to teach patients that in most cases, these are problems that can be addressed conservatively," concludes Karkuff. DDD is something that most of us can expect in our lifetime and it is something that can be managed quite successfully with physical therapy.

By Gary Karkuff, PT

Resources

Hilton, Lisette. Behind the Label: A Look at Cervical DDD. Today in PT, Feb, 2008. 

Matsumoto, M., Y. Fujimura, N. Suzuki, Y. Nishi, et al. 1998. MRI of cervical intervertebral discs in asymptomatic subjects. Journal of Bone Joint Surgery 80-B: 19-24.