Osteopath
3 steps:
a) Detailed history is taken regarding how the pain began, description of pain and symptoms (pain, numbness &/or pins and needles down the leg) and activities or position that may make the pain worse i.e. sitting, bending forward.
b) Physical assessment: focusing on lower back and legs. May include range of motion, muscle strength testing.
c) MRI or CT scan: formal diagnosis and helps determine severity.
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It is also pertinent to note, that as the inner two thirds of the disc does not contain nociceptors (pain receptors), degenerative disc disease may preceed pain. I.e. may be occuring in the background without symptoms.
XRay examination may also be used to determine degenerative disc disease (based on a “vacuum sign” and loss of disc height). It is considered a normal finding to have an amount of degenerative disc disease after 60 years of age.
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The best readily available diagnostic tools for a degenerative disc are the MRI and CT scans.
As mentioned above, a detailed history and physical assessment also play an important role in any well rounded and in-depth diagnosis.
It is interesting to note that a diagnosis of “degenerative disc disease” in relation to back pain may not necessarily completely explain the symptoms that someone may present.
There is most likely a large portion of the middle to late aged population that currently have varying degrees of painless disc degeneration. So the onset of pain may not always be based purely on the presence of disc degeneration but other soft tissue, facet joint and circumstantial factors.
In summary, the MRI/CT scans are fantastic at picking up degenerative disc disease, however it's presence should in no way be solely linked to any symptoms present.
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