Jeff LangmaidFounder, The Evidence Based Chiropractor

Why Movement Beats Fusion for Back Pain

30 Dec 2024 · 1 min

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Jeff Langmaid argues that improving motion segment mobility (through movement and spinal manipulation) can yield better outcomes for some patients with degenerative disc conditions than surgical fusion. He contrasts hypomobility and stiffness of intervertebral discs—linked to collagen changes in the annulus fibrosus—with the theory that some segments can become unstable or hypermobile, and warns that fusion stops motion and can create adjacent-segment problems. The speaker promotes movement-based care as often preferable to fusion.

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Spinal manipulation we know treats mechanical aspects of pain and specifically relative to hypomobility and with decreased water content in the disc, specifically a degenerative disc, it's theorized that motion segments can become unstable or hypermobile. But there's a lot of literature out there supporting the fact that the intervertebral discs might become stiffer and hypomobile due to changes in the collagen of the annulus fibrosis. Really interesting and that has a lot of implications for what we do. So improving motion segment mobility may provide better outcomes than surgical fusion in some patients. Why? Because fusing it, we know it leads to adjacent issues but it also it fuses the segment and motion might be what getting back to motion based. In a movement based healthcare profession, movement is generally what things need to improve. So when you fuse it, you stop all healing and you actually advance challenges in the adjacent areas. Whereas movement might be the best thing and is often the best thing to do.