09 May Is Your MRI Lying To You?
You have had low back pain off and on for many years. It initially is bearable and normally goes away after a couple days. As time goes on your low back pain gradually returns more frequently and begins to intensify. You have increasing difficulty sitting at your job where you have to be behind a computer screen for 8 plus hours a day, which is affecting the quality of your work.
You go home and you begin to notice you are having trouble doing your normal chores around the house. You cannot go on your nightly walks with your significant other. You can no longer lift your child up anymore because your back pain is now excruciating. You see your physician because you want pain relief.
The physician orders you an x-ray/MRI with results of spinal stenosis, maybe a disc bulge, possibly degenerative disc disease, or just plain old arthritis; heck you may have been told you have all of these things. You are also prescribed medicine which helps some of the time but your low back pain never really goes away.
Perhaps you get an epidural injection but as always your pain relief is temporary. Hot packs. Cold Packs. Massage. Nothing gives you long term relief. Now you have begun to consider getting surgery. Some of you reading this may have already had low back surgery yet you still have the same amount of pain as you did before surgery.
This is a scenario I see all the time. It’s a situation many people face. You’re afraid that your back pain is going to be part of you for the rest of your life. Many people will tell me “I guess this is just what happens when you get old!.” Normally when I hear that phrase I secretly do one of these…
Then I smile, take a breath, and begin to help people better understand what is going on with their body. But first….some background information.
According to a scientific study performed in 2006, total costs of low back pain in the United States exceed $100 billion in which two-thirds are a result of lost wages and reduced productivity*. This is a terrifyingly high number and clearly a huge problem in today’s society.
But what if I told you that spinal stenosis, disc bulges, degenerative disc disease, and arthritis may all be a part of the normal aging process? What if I told you that there was a massive study done in April 2014 and reviewed the lower back MRI results of over 3000 PAIN-FREE adults ranging from people in their 20’s to their 80’s with the results in the image below**…
Remember all these patients are pain-free and yet 80% of people in their 50’s showed disc degeneration of their lumbar spine…even 37% of people IN THEIR 20’s had some form of disc degeneration WITHOUT low back pain. So what gives?
To get a better understanding we must know how pain works.
First and foremost, pain is a protective response and is necessary to survive as a human being. Pain originates from your brain. From your brain stems the spinal cord which then becomes peripheral nerves that reach all over your body. These peripheral nerves sense heat, cold, pressure, and of course pain. It’s easiest to look at your nervous system as an alarm system.
For example, let’s say you step on a nail. Well this alarm system immediately starts going off and your reaction after yelling and cursing is to get the nail out of your foot. When you do take the nail out of your foot does 100% of your pain go away? No, right? It’s still sore and it’s difficult to put weight on that foot. Your alarm system is now much more sensitive and it’s painful just to walk 5-10 minutes when before you could walk as long as you wanted.
Adriaan Louw, a pain researcher, makes a perfect analogy that I’m going to steal borrow. “Pain is like a home security system. I go to your house and bash the window in, the alarm goes off. Now your alarm system is so sensitive that the next time even a leaf touches your window the alarm goes off.”
Now, tissues DO heal, but the alarm system (your nervous system) has increased sensitivity to protect you. This is a normal response in every human being. This alarm system tends to not go back to normal levels because of fear of certain movements. This is especially true in those with chronic low back pain (back pain lasting 3 months or longer). You don’t want to bend over to pick up the groceries off the ground because your alarm system has linked movement (bending over) to pain. People get confused because healthcare providers do not provide a clear-cut answer to where their back pain is coming from so naturally we believe that an MRI will tell us exactly what is wrong.
At this point some of you might be thinking in a sarcastic tone, “Gee thanks Mat, so you’re telling me that my MRI may not really indicate anything, that this pain is all coming from my head, and my alarm system (nervous system) is on high alert?”
Don’t worry because I believe I can help you!
The first thing I recommend you do if you have low back pain is to go see a physical therapist. Physical therapists have many different strategies to help you move better and get you back to the activities you love doing.
“But, Mat I’ve been in pain for so long isn’t exercise going to make my pain worse?”
NO! In fact, there is research that has shown exercise can help decrease stress and calm the alarm system. When back pain has been around for 3 months or longer your tissues (discs, joints, ligaments, muscles) have normally healed; it is more than likely your alarm system that is overly sensitive.
So when you exercise and have had pain for longer than 3 months, remember just because something hurts doesn’t mean you’re causing tissue damage, it could be your alarm system telling you that you’re exercising. Remember, pain is a response to the perception of threat.
Back pain does not have to be a life sentence and if you’ve tried physical therapy with no improvements, then download my ebook “Beating Back Pain” which gives strategies and tactics to get you out of pain!
- Back pain is not a life sentence!
- Pain comes from your nervous system which acts like an alarm system. When your pain signal goes off your alarm system becomes much more sensitive to certain movements, stresses, and fear.
- Pain doesn’t always equal harm or tissue damage. Tissues heal!
- If you do have low back pain, GO SEE A PHYSICAL THERAPIST or download my ebook.
* = Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [review]. J Bone Joint Surg Am. 2006;88(suppl 2): 21-24.
** = Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR American journal of neuroradiology. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.
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