Have you ever seen or heard of a family member who had an MRI of their lower back and were told:
“Your back is degenerative”
“You have a slipped or bulging disc”
“Your back is like an 80 year olds”
Back pain is prevalent, and is increasingly common in members of all ages. It isn’t uncommon to see a 20 year old student experiencing the same debilitating back pain of a person who is 50 years old. Regardless of age, common thoughts that many have following the acute onset of lower back pain is:
Is this permanent
Will this ever go away
Will I ever be the same
The Initial Fear of Lower Back Pain…
The first point of action for most individuals is to seek our professional healthcare advice, usually from a physiotherapist or a doctor. Unfortunately, there are still many healthcare professionals who will immediately send you off for a scan of your lower back. Then, tell you there’s “nothing that we can do about it“ until the scans come back.
This leads into a negative spiral as individuals can depend on the results of the MRI scan as a “life or death” diagnosis. Namely, the severity of their lower back pain and their outcome is dependent on the results seen on the scan.
However, as I have mentioned in my previous lower back pain post, pain is multifaceted and cannot be attributed to only one cause. As I will allude to in a second, there is no supporting evidence that directly links the results of the scan to lower back pain.
Compare the following statements:
- Individuals who have severe anatomical or pathological change on their MRI can have minimal or no pain, but
- Individuals that have minimal anatomical or pathological change on their MRI can have severe pain
So what’s the difference and why do some people get pain?
The Complexity of Pain…
Pain is complex… If you want to see scientific discourse on the ambiguity of pain, I would highly recommending reading this article by Treede (2018). Our understanding of pain is only continuously evolving and there are still many things that we need to learn in order to truly understand “pain.”
“… Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons.”
The interpretation of pain includes cognitive (i.e. our emotional association and relationship with the pain or threat) and social dimensions (i.e. our interaction or lack thereof with family, friends and peers)Treede (2018)
When assessing pain, tissue pathology and actual injuries are not the only factors that we must consider. In modern healthcare, we commonly have a paradigm which we follow called: The Biopsychosocial Model of Health / Pain. Essentially, the interpretation of pain can be defined in three seperate factors / cateogories:
- Biological factors (e.g. physical health, genetics, age etc.)
- Social factors (e.g. relationships with family, friends or peers, work or stress issues)
- Psychological factors (e.g. depression, anxiety, self-efficacy)
As we know, emotional factors such as stress and anxiety can elevate and heighten our perception of pain. Similarly, if we were taught pain was a very bad sensation when we were young, then naturally we may develop a fearful response to it when it does happen. However, this is outside the realm of this blog post and will be explored further in the future!
So What About the MRI?
The interpretation of lower back MRI’s often give you insight into many pathological anatomical changes. The most common of which include:
- Disc bulge
- Disc degeneration
Interestingly enough, lower back pain is not actually synonymous with disc pathology. One study from 1990 by Boden and colleagues researched MRI results on 67 volunteers who had no history or current symptoms of lower back pain. What they found was:
- 20% of people aged 20 – 59 had abnormal scans
- 57% of people aged >60 had abnormal scans
- 54% under 60, and 79% over 60 had bulging discs
- Perhaps most extraordinary, 93% of people aged 60 and older had degenerated discs.
Let me just repeat that last one for you. 93% of people aged 60 and older had degenerated discs, but had no lower back pain. So you’re thinking, that’s insane. There’s no way that you can have degeneration and bulging discs without pain?
Unfortunately, with our current medical technology, we are unable to directly propose that scan result = pain. The only way that we would be able to attribute or interpret your MRI results to lower back pain is:
- If you took a scan directly prior to your injury that showed an absence of any pathological changes
- If you took a scan directly after your injury that showed a pathological change at the area of your pain
The Slippery Disc
A common fear that many individuals have is “slipped discs.” Fortunately, there’s no scientific literature or reasoning to support discs “slipping.” There’s just too much structural and anatomical stability around the area to allow for a disc to slip. An excellent article written by Dr Jarod Hall titled “Discs don’t slip DAMMIT” outlines these specific concerns and the reasoning behind it.
So if you did have an MRI scan and have been diagnosed with a bulging disc, do not worry! The research shows that a disc can actually REABSORB and present you with a ‘normal’ MRI scan. Yet again another amazing article written by Dr Jarod Hall titled “What if I Told You That……Discs Heal!?!?” talks in detail about the spontaneous healing or “regression” of a bulging disc.
A Word of Caution
As I mentioned in my lower back pain blog post, you need to be aware of any red flags. This includes:
- Unexplained weight loss
- Night pain not relieved by rest
- Saddle anaesthesia (numbness of the buttocks, perineum and inner surfaces of the thigh)
- Bowel and bladder incontinence (unable to go) and retention (unable to hold)
- Drastic changes in strength or sensation in legs
- Any recent significant trauma
- Gait / walking abnormalities
Adapted from Ramanayake & Basnayake (2018)
This could be indication that you need to have an emergency consultation with your doctor, or visit the emergency department of your local hospital. Similarly, a trip to your local healthcare professional should be considered if you have ongoing concerns regarding your lower back pain or your condition suddenly deteriorates.
Lower back pain is common amongst all ages, and is something that we need to consider as we grow older and change. The main takeaways from this article can be summarised as follows:
- Pathological changes on your MRI results DOES NOT equal pain
- MRI are usually only required to rule out serious, medical emergencies
- 93% of people aged 60 and older had degenerated discs, but had no lower back pain.
- Discs cannot slip, but they can bulge. Fortunately, bulging discs are not always painful and can also heal by themselves!
Lower back pain is scary, but hopefully these blog posts will help with your knowledge and understanding of them!
How would you explain this to your friend or family or coworker that had lower back pain?
- Boden, S. D., Davis, D. O., Dina, T. S., Patronas, N. J., & Wiesel, S. W. (1990). Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. The Journal of Bone and Joint Surgery. American Volume, 72(3), 403–408. https://doi.org/10.2106/00004623-199072030-00013
- Ramanayake, R. P. J. C., & Basnayake, B. M. T. K. (2018). Evaluation of red flags minimizes missing serious diseases in primary care. J Family Med Prim Care, 7(2), 315 – 318.
- Treede R. D. (2018). The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain reports, 3(2), e643. https://doi.org/10.1097/PR9.0000000000000643