In our journey through life, we celebrate and lament the various changes our bodies undergo. Among these transformations, gray hair is often met with admiration, labeled as the sign of a "silver fox" or a mark of wisdom. However, when it comes to the natural aging of our spine, the terminology takes a drastically different turn. The term “degenerative disc disease” (DDD) sounds ominous and severe, conjuring images of chronic pain and disability. This stark contrast in nomenclature reveals much about our perceptions and anxieties surrounding aging and health.
Perception Problem
The term “degenerative” itself carries a heavy burden. It evokes images of decline and decay, suggesting an inevitable and progressive worsening. This perception can be especially daunting when applied to something as central to our mobility and quality of life as the spine. However, DDD is a misnomer for what are largely normal age-related changes. Just as gray hair and wrinkles are visible signs of aging, the discs in our spine naturally lose some of their hydration and elasticity over time.
Age-Related Changes:
A Universal Process Everyone's body undergoes these changes. The spine, which bears much of our body’s weight and absorbs the stresses of daily activities, gradually shows signs of wear as we age. Research has shown that the prevalence of abnormalities detectable by MRI in the spine increases significantly with age. A study published in the New England Journal of Medicine found that by the age of 50, approximately 80% of people have disc degeneration visible on MRI scans, even if they have no back pain symptoms.
Discrepancy Between Imaging and Symptoms (You are not your MRI)
This brings us to a critical point: the presence of age-related changes on MRI often does not correlate with pain or functional impairment. Numerous studies have demonstrated that many people with MRI findings suggestive of “degenerative” conditions experience no pain at all. Disc bulges, herniations, and signs of degeneration are commonly found in individuals without any back pain. This disconnect between imaging results and clinical symptoms suggests that the terminology and the subsequent interpretation of these findings may unnecessarily alarm patients and lead to unwarranted anxiety. If we were to rename these changes as “age-related disc changes” instead of “degenerative disc disease,” it might foster a more accepting and less fearful view of these natural processes.
Reframing the Narrative
Consider the positive connotation of gray hair as a “silver fox” – a term that celebrates the grace and maturity that come with aging. If we adopt a similar approach to spinal changes, referring to them as “age-related spine changes” or “natural spinal aging,” we could significantly alter the perception and emotional response associated with these changes. Changing the narrative from one of degeneration to one of natural evolution acknowledges the body's remarkable ability to adapt and remain functional even as we age. It can also alleviate the fear that something has gone “wrong” simply because changes appear on an MRI scan. Understanding that these changes are a normal part of aging can encourage individuals to focus on maintaining overall health and mobility, rather than becoming preoccupied with the inevitability of decline.
Psychological Impact
The language used in medicine not only shapes patient perceptions but also influences their psychological well-being. Terms that imply disease or deterioration can create a sense of helplessness and fear, potentially leading to a decrease in activity levels and a decline in overall health due to a misunderstanding of what is a benign condition. Think about it, degenerative disc disease sounds scary. It is easy to think that if I keep exercising, strength training, or playing golf you will do irreparable damage. By contrast, language that frames these changes as a normal part of aging can empower individuals. It can promote a more proactive approach to managing their health, focusing on lifestyle modifications, exercise, and preventative care rather than resignation to a “disease” process.
Moving Forward
As our understanding of the body and aging evolves, so too should our language. Just as we celebrate the beauty of gray hair and the wisdom it represents; we should reframe our view of spinal aging. By recognizing “degenerative disc disease” for what it truly is – a series of natural, age-related changes – we can foster a more positive, less fear-driven approach to aging. Embracing these changes with the same acceptance and grace as we do with other signs of aging will help us to live healthier, happier lives as we grow older.
Strength training should be a part of your plan as an athlete of aging. Please reach out if you are ready for your journey of strength.
References:
1. The New England Journal of Medicine (1994). Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J. S. "Magnetic resonance imaging of the lumbar spine in people without back pain." [Link to study](https://www.nejm.org/doi/full/10.1056/NEJM199407143310201).
2. European Spine Journal (2015). Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., & Jarvik, J. G. "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations." [Link to study](https://link.springer.com/article/10.1007/s00586-014-3561-9).
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