Diffuse Idiopathic Skeletal Hyperostosis (Forestier’s Disease): A Concise Narrative Review with Physiotherapy Management

Author

Smrutiranjan Sahu, Priyabrata Dash, Avinash Tiwari, Nihar Ranjan Mohanty


Abstract

 Background: Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a systemic skeletal condition characterized by excessive bone formation at entheses and flowing ossification along the anterolateral aspect of the spine. Although frequently asymptomatic, it may cause spinal stiffness, restricted mobility, pain, dysphagia, and neurological complications.

Objective: To summarize the current understanding of the epidemiology, pathophysiology, clinical presentation, diagnostic criteria, and conservative management of DISH, with particular emphasis on physiotherapy and rehabilitation.

Methods: This narrative review synthesizes established diagnostic criteria and selected peer-reviewed literature addressing the clinical, radiological, and rehabilitation aspects of DISH.

Results: DISH is associated with advancing age, male sex, obesity, diabetes mellitus, and other metabolic abnormalities. Diagnosis traditionally relies on the Resnick and Niwayama radiographic criteria. Management is primarily conservative, incorporating education, individualized therapeutic exercise, mobility training, and treatment of associated musculoskeletal impairments. Particular caution is necessary because spinal ankylosis increases the risk of unstable fractures following relatively minor trauma.

Conclusion: Early recognition and individualized rehabilitation may help maintain functional independence and manage symptoms in people with DISH. Further research is required to establish disease-specific physiotherapy protocols and evaluate their long-term effectiveness.


Keywords

Diffuse idiopathic skeletal hyperostosis; Forestier’s disease; spinal hyperostosis; enthesopathy; physiotherapy; rehabilitation.



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References


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