You may have been told that your back hurts because of any of the following:
You have a degenerative disc
You have a leg length discrepancy
You have too much curve in your lower back (lumbar lordosis or anterior pelvic tilt)
You have a herniated disc in your lower back
Without a doubt, X-rays and MRI’s are helpful in determining what structure lies within us, but what these pictures cannot do is determine why you have lower back pain.
The human body is an amazingly complex organism that is constantly changing and adapting or our activities or inactivity. The normal aging process also results in normal changes over time that can be incidental findings on an X-ray or MRI.
Sometimes these changes mean something. Many times they don’t.
Once we were able to “see inside the body” via the various scans, it was easy for us to default to the changes in the structure joints and muscles as the source of lower back pain. It seems logical to think that anything that didn’t follow the normal structure found in anatomy books must be a source of pain, discomfort or lack of mobility.
However, we now know better that just because something shows up in a picture (aka X-ray, MRI, CT scan, etc.), it doesn’t mean it is the cause of your lower back pain.
Wouldn’t it be interesting if we took X-rays or MRI’s of people that had no pain at all just to see what their spines looked like?
Actually, there is quite a bit of research regarding the various scans on pain-free people, and the results are very enlightening.
Does everyone with degenerative disc disease have lower back pain?
No.
“There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated.” (Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. Boden SD1, Davis DO, Dina TS, Patronas NJ, Wiesel SW. J Bone Joint Surg Am. 1990 Mar;72(3):403-8)
Does everyone with a leg length discrepancy have lower back pain?
No.
“Chronic back pain is thus unlikely to be part of the short-leg syndrome.”(Does unequal leg length cause back pain? A case-control study. Grundy PF, Roberts CJ. Lancet. 1984 Aug 4;2(8397):256-8)
Does too much curve in your lower back always cause back pain?
No.
“Nor could we demonstrate any difference in the degree of lordosis among women with or without back pain.” (Lumbar lordosis: study of patients with and without low back pain. Murrie VL1, Dixon AK, Hollingworth W, Wilson H, Doyle TA. Clin Anat. 2003 Mar;16(2):144-7.)
Do all herniated discs cause lower back pain?
No.
“52 percent of the subjects had a bulge at least one level, 27 percent had a protrusion, and 1 percent had an extrusion.” “On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.” (Magnetic resonance imaging of the lumbar spine in people without back pain. Jensen MC1, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. N Engl J Med. 1994 Jul 14;331(2):69-73)
Do these findings mean we should just ignore our X-rays or MRI’s?
Of course not. These tests are helpful in that they provide information, and that information should be respected. The key point to understand is that your X-ray or MRI is not an absolute. It doesn’t mean that you are destined to live with ongoing pain.
It means there may be a solution to your lower back pain regardless of your MRI or X-ray.,
Every day, we see people at IFAST Physical Therapy who present with any number of findings on a test from herniated discs to hip labrum changes to rotator cuff tears.
Each person must be seen as an individual to determine the influences on their pain. In many cases, our patients overcome such findings and recognize that their structure doesn’t equal pain.
Even if you’ve bee through physical therapy before or told there’s nothing you can do to resolve your back pain, there may still be a solution. IFAST Physical Therapy specializes in such complex cases.
Consider taking advantage of the IFAST Physical Therapy Free Injury Consultation. You’ll be able to ask questions and discuss your concerns and determine if there is a solution.
Call today to schedule your free consultation at 317-578-0998 or email us at [email protected]
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