What does ‘degenerative change’ actually mean?

Once upon a time, when patients presented to their doctors with lower back pain, the first point of call was to order an X-Ray of their lower back, to see if there were any significant changes in their spine that may be causing the back pain. Patients would present back with age-related tissue changes, including osteoarthritis, disc bulges and facet joint degeneration. These are things you might have even read on your own X-Ray at one point, and these were the things that are then blamed for your lower back pain.

BUT… and this is a big but. Research is increasingly finding that these degenerative changes are a normal part of aging. And that is why we should always refer to degenerative change as age-related change. Not only are these age-related changes that are commonly found in spine imaging (and knee and hip imaging… but that’s another story), people who have these changes are often pain-free individuals as well as those with back pain.

The question that then lies with us as physiotherapists, is why do some people with degenerative tissue changes hurt, and others don’t? The answer to this is super complex. That is because many factors modulate pain. Do you need to change the structure of your spine to be out of pain? The answer is no.

To put it simply, spontaneous onset of pain is triggered by the unmasking of normally muted nociceptive activity (that is your brain’s pain sensors). Things like feeling low, coping poorly, being under stress and mental states can cause your brain’s pain sensors to fire up. Other things include strains or injuries where you’re putting your body through too much load (lifting something heavy), or not enough load (long periods of bed rest because of illness… or social isolation).

Too often patients will come and see their physiotherapist with no obvious physical incident that may have caused their back pain, and that is because of the many factors (such as those above) that contribute to pain. Sleep, stress, activity, diet… these are more examples of the millions of factors.

It’s not simply a matter of a ‘weak core’, or ‘weak glutes’, that are the cause of your back pain. Other wise – you would have been in pain a lot earlier.

Therefore, it’s not necessarily the muscles getting fitter, or the joints being more mobile, that is the trick, it is the context in which you use them i.e. strengthening or loading your body so it can withstand the daily loads you put them through.

Still confused why you’re in pain? Get in touched with one of our physiotherapists today and we can figure this out together.


Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR American journal of neuroradiology. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.

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