Lower back pain is widespread across human populations. It is a scourge. Back pain is also one of the leading causes of disability worldwide, and enormously expensive to treat, taking up vast sums of healthcare dollars in a supermarket bonanza of treatment options from over-the-counter lotions, creams, and potions all the way to surgeries costing tens of thousands of dollars.
When a patient comes in complaining of lower back pain they want answers. They may be scared and anxious. My patients often search online for their symptoms and what that ache or stabbing in their back can mean, they read horror stories and anecdotes which heighten their dread. When they ask me what could be causing their pain they often want an MRI to confirm a diagnosis.
A good doctor who takes a detailed history, listens to you, performs a competent exam, and gives reasonable advice and a treatment plan that aligns with your goals and expectations…this approach has been well studied and there is much evidence to demonstrate it’s superiority over expensive MRI scans and cookie cutter treatments.
The Need To Know
Yet, there is the human desire to KNOW what is going on inside our bodies. There are also costs to knowing that you have a disc protrusion, or osteoarthritis, or degenerative disc disease.
What that MRI won’t tell you is that the prevalence of disk degeneration in asymptomatic individuals increases from 37% of 20-year-old individuals to 96% of 80-year-old individuals¹.
An MRI is great at showing tissue structure such as discs, cartilage, and tendons. An MRI will not show you what hurts, not definitively.
Your story, experiences, and your doctor’s exam should do a much better job in most cases in identifying the culprit. Imaging for many cases can not determine the age of these findings, sometimes providers are not skilled in identifying old versus new injuries, sometimes it is just impossible to tell. The imaging findings may correlate with your symptoms, or they may not, or they may match up with what you are feeling AND still not be the pain generator.
Say you are a runner. You’ve been running for decades and have had various minor injuries, aches, and pains. Now you are in your 50’s and your back starts hurting after a run, like it has on occasion many times over the years, but this time it lasts a little longer and is more intense than before, so you seek care with your primary doctor and they prescribe you some Ibuprofen and tell you to take it easy for a couple weeks. Two weeks pass and your back doesn’t feel much better, you go back to your doctor and they order an MRI.5 Steps To Overcome Long COVIDPost-Acute Sequelae of SARS CoV-2 infection, or PASC, is increasingly reported. Here’s what you can do to combat these…medium.com
The MRI shows a disc protrusion at L5-S1 and mild osteoarthritis at multiple levels. What the MRI doesn’t tell you is if you take 100 people without back pain off the street, on average 36 of them are going to have a disc protrusion at your age. So is the disc protrusion causing your pain? The MRI can’t tell you that, but now you know you have a disc protrusion, maybe your doctor tells you to stop running so as to not make it worse, maybe you are referred to a surgeon for an injection. There is a whole cascade of possible outcomes, none of which have been shown to be all that helpful versus a gradual return to general exercise and a wait and see approach.
All that care is very expensive though, and healthcare is a business, and lower back pain is a $100 billion a year subset of that industry.
You Can’t Unsee Your MRI
With 36% of people in their 50’s out there running around with disc protrusions and not having any symptoms, it may be hard to believe a radiologist pointed it out on your scan and it might not be important as a source of your pain.
However, many normal changes that occur with aging are routinely noted as abnormal.
Try to remember that wrinkles do not hurt, greying hair is not painful, and that rotator cuff or labrum tear, disc bulge, or torn meniscus…could just be part of the bodies normal aging process.
Find a doctor, chiropractor, physical therapist, or other licensed health care provider who takes a detailed history, performs a thorough examination, and works with you on goal setting and an individualized treatment plan.
Brinjikji, W et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR. American journal of neuroradiology vol. 36,4 (2015): 811–6. doi:10.3174/ajnr.A4173