Diagnosis of DDD?

Pain & Rehab Forum [Moderated]
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Had this case at PT school for a group assignment and everyone was so fixated on the DDD and spondy (specifically DDD since spondy was only grade 1) as the diagnosis. From my understanding it wouldnt be an anatomical issue thats necessarily causing this person the pain, wat im seeing here is a load management issue. This person out of nowhere removed a whole fence om his own we also dont really know how the low back pain started (which sucks that the case is incomplete bec id love to know a lot more about this patient). I tried argueing non-specific LBP but my group didnt agree and then the prof also mentioned that its an exacerbation of his DDD and we confirm thag by our assessment by finiding restricted ROM at the spinal segments in all directions and capsular end feel (similar to OA) my question is can we even really feel “restricted ROM at the spinal segemnts” and even if we could would our diagnosos be DDD and even if it was would our managment be any different than if it was non specific low back pain? (which i mean to my groups point it would be bec then we would be “mobilizing” each segment using PIVMs

case:

72 year old male with 3 month history of low back pain. He has noticed some stiffness in his low back in the mornings but generally it goes away with his morning stretching routine. He does a 10 minute stretching routine in the morning and walks 3km daily at lunch. He is very active around his house and in the summer at his cottage, taking care of the lawn and garden. After a strenuous week removing an old fence at his cottage and digging holes for a new fence he began to notice that bending, twisting or lifting felt tight and that the morning stiffness lasted longer or didn’t go away completely after his stretches. Sitting for more than 30mintues also seems to increase the stiffness and tightness in his low back. Besides his stretches he has found that heat helps or lying down. He hasn’t had any trauma and reports being active all his life in sports and continues to enjoy golf and doubles tennis. He likes to help out in the garden with his wife and when his grandchildren come to cottage he likes to go hiking and canoeing with them. He saw his doctor about a month ago and had a xray that reported “multilevel degenerative disc disease, notably at L3/4/5/S1 and associated facet arthropathy on right greater than the left with a grade 1 anteriolithesis at L4/5”. He had a heart attack when he was 65 years old, he had an angiogram where 3 stents inserted. He went to cardiac rehab for 6 months, where he got his stamina and strength back. He lost 15 lbs following his heart attack and limits the amount of red meat and wine he drinks. He has no heart symptoms since then and sees his cardiologist yearly for regular check ups. He had hip replacement on the left when he was 68 years old and he feels he got back most of his range but his previous physio said he didn’t have full hip extension. The physio gave him hip flexor stretches, which he does regularly and that helps his hip move better and can help his back as well. His right hip has osteoarthritis, and with prolonged walking or sitting is really stiff and can be painful in the groin and buttocks area. He has a follow up with the orthopedic surgeon in 6months to determine if surgery is necessary.

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Nada.zksh thanks for the questions. There’s a lot here to unpack that would likely necessitate more conversations beyond the forum. To your questions, we can claim to feel all sorts of “things” but often we are entertaining ourselves and the patient. Based on the case context you supplied here, this isn’t something I would worry about nor attempt to check. This is a great example of how our supplied narratives to explain someone’s pain experience lays the foundation for intervention and management rationalization. It’s good you are beginning to see the cracks in the foundation already. Overall, the question isn’t does DDD matter or not but rather how much does such a finding matter. In the case context you’ve provided here, my skepticism is high the diagnosis matters sufficiently to change recommendation for usual management. We need to frame these questions from the standpoint of “how much” something matters otherwise we see folks slipping into the ideas of “think away pain” and “unlearn pain” and DDD is irrelevant, which isn’t a good spot to operate from either. For some cases, some of the time, this may be a relevant finding to correlate with patient’s presentation and alter recommendations for management - this isn’t one of them from what you’ve relayed here. I agree with you, based on the case information you’ve supplied, this is likely an opportune time to have a conversation about the individual’s pain experience, their understanding and meaning assigned to such experiences, and how they typically respond. Some of this conversation can be centered around load management, while advocating for activity to tolerance. Hope that helps.

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Thanks @Michael_Ray this does help a lot clarify some things ive been pondering. Like you mentioned one of the biggest things i struggled with is swinging the pendulum way too much but like you said its about “how and why does this matter” and not getting too focused on one thing but approaching the patient as a whole and working with whatever they present with and can tolerate