The Signs and Symptoms of Discogenic Low Back Pain
Abstract
The signs and symptoms of low back pain (LBP) associated with disc herniation (DLBP) and its underlying mechanism(s) are not well supported. One theory proposes that some low back pain (LBP) is the result of a disc herniation compressing adjacent tissues innervated with nociceptors. The theory proposes that spinal manipulation (SM) and/or mobilizations (SMOB) can reduce the size and position of the herniation, and relieve pain and improve range of motion. There is no research to support or negate the theory even though clinical evidence supports its plausibility.
In this three-part study we examined clinical practices that have an anecdotal history of success. Part one consisted of surveying international clinicians in order to determine their perspectives on the signs and symptoms of DLBP. We then compared those views against published literature through a systematic review. The third part of the study used magnetic resonance imaging (MRI) technology to examine for evidence of change in order to test the hypothesis that disc morphology (i.e., the size and position) can be altered through a specific spinal movement or position. Our findings showed that clinicians who screen for DLBP appear to follow what little guidance is available however most rely instead on theory, experience, and intuition. Despite the large numbers of proposed features of DLBP, this study shows that there is a need to develop valid and reliable criteria for it’s diagnosis. With the exception of the centralization phenomenon, there remains no consensus on reference-based index tests that would help clinicians to identify DLBP. There remains a gap between clinical practice and evidence on the use of spinal manipulative therapy (SMT) for LBP. Currently there is no clear evidence to assist clinicians to determine the subgroup of LBP patients that respond best to SMT. This study demonstrated a reliable method for measuring changes in disc shape. Future studies should focus on understanding these responses in larger and more diverse samples, as well as their clinical relevance in patients with existing discogenic low back pain.