Understanding Your Low Back Pain
Low back pain has been a term and a condition that has troubled medical professionals for years.
It’s not always as straightforward as a rotator cuff tear in the shoulder or an ACL tear in the knee. The rotator cuff tear and the ACL tear are so well researched that we have degrees of tears, refined surgical procedures to help if the tear is big enough, and excellent rehab protocols for conservative or post surgical recovery. When it comes to low back pain, there is a lot of research, but the research is ultimately inconclusive when it comes to non-specific low back pain. Non-specific low back pain simply means, a diagnosis without a specific cause like a fall from a ladder or a car accident. Sometimes practitioners still try to find a “diagnosis” for someone who woke up one day with back pain and no real cause for it. I put the word diagnosis in quotations because on x-rays and MRIs there are many findings that can be seen in an aging population that may or may not translate directly to the person’s pain complaints.
We cannot always hang our hat on the findings we get from images. A 2014 research article from Brinjikji and colleagues in the American Journal of Neuroradiology reviewed 33 other articles that looked at changes in the non-painful spine as people aged. They broke down the age categories and spine changes to reveal some interesting details about people’s spines who don’t have pain.
This should not be cause for alarm. These findings should tell you that if you have back pain that “came out of nowhere,” then it’s not likely due to some of these changes commonly seen in the spine as we age. If you are around the age of 50 years old and don’t have back pain, it’s likely you have disc degeneration and/or disc bulging already. So if you do get back pain within the next 3 hours to 30 years, we cannot be certain that your pain is coming from degeneration or bulging of the discs and could be more related to strength, mobility of the spine, and lifestyle choices. Let’s even look at the 30 year olds, 1 in every 3 people in their 30s who do not have pain have a disc bulge or a disc that is degenerating. Some of the most influential people in the physical therapy and performance world consider these changes in the spine as we age no different than our skin having wrinkles. It’s normal!
Here’s another interesting article that followed a 63-year old woman to 10 different MRI clinics within a 2 week time frame. After 10 MRIs performed over the two week period, there were 49 different findings across all 10 images. 49!!! I am sure you all have tried seeking out second opinions from other providers and got really different answers from 2 experts in their field of study. It’s frustrating! I get it! I have had multiple patient’s come in for my services and tell me how frustrated they are that no one can give them an answer on their diagnosis. My response is usually to ask this one question, “Even with your pain being labeled under a diagnosis, would that even change the goals you have for yourself which is to move better, get out of pain, and go back to (insert fun activity here)?” The answer most of the time is a resounding no!
We should not be and are not defined by our back pain or any pain for that matter. How many times have you been told to not squat again or don’t EVER twist through your back! These “rules” are not founded on any hard evidence. Most is just the provider’s own opinion or what a colleague had told them to say. I’m not blaming anyone here other than the system in which we operate. We do not need to feel pressured to get an MRI from friends, family, or providers. We also do not need to seek our short term fixes like steroid packs or NSAIDs which in the long term can break down our tissues and make matters even worse.
There are a lot of adults who experience pain on a daily basis and do not know what to do or only have short-term solutions for dealing with their pain. Platinum Rehab Specialists gives the adult a clear plan to improve their pain, fitness capacity, and overall health. Many others have had success with Platinum Rehab and if you are struggling to keep yourself healthy and active due to pain or lack of knowledge on where to start, then please reach out to me directly at my contact information at the bottom of the page so we can eliminate your fear and pain and get you doing the things you love!
- Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, J.G. Jarvik. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology Apr 2015, 36 (4) 811-816; DOI: 10.3174/ajnr.A4173
Richard Herzog, MD, FACR.Daniel R. Elgort, PhDb. Adam E. Flanders, MDc. Peter J. Moley, MDa. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. The Spine Journal. 2017, 554-561. DOI: http://dx.doi.org/10.1016/j.spinee.2016.11.009