Low back pain is very common in the general population with approximately 80% of people experiencing back pain at some point in their lives (Daulat, 2013). Many people with back pain are anxious to have a scan to investigate the apparent cause of their pain.
According to Timothy Maus, an American Researcher:
“Imaging is an integral part of the clinical examination of the patient with back pain; it is, however, often used excessively and without consideration of the underlying literature” (Maus, 2010).
Excellent research suggests that unwarranted scans (imaging) may in fact make pain worse (Deyo, 2013). This may be because a scan may reveal what are often normal changes in the spine which occur as we age and may have very little to do with the pain being experienced. However the concern and possible anxiety this information may cause, if not explained correctly, may in fact exacerbate the pain being felt.
The main role of imaging is in the diagnosis of a serious pathology as a cause of back or limb pain (Maus, 2010), this may include a fracture, a tumour or infection for example. However, it is important to note that only 1-2% of low back pain patients have a serious pathology (O’Sullivan & Lin, 2014). The majority of back and radiating limb pains are not due to severe medical conditions and is more likely to be ‘mechanical’ in nature.
“I've had a scan for my back – what do the results mean?”
Often, MRI results come back reporting “wear and tear”, “disc degeneration”, or “disc bulges”, among other things. These kinds of reports worry patients about the structure and well-being of their spine. What many patients are not aware of is that these are normal and common findings. In the words of Peter O’Sullivan, Professor and Specialist Musculoskeletal Physiotherapist at Curtin University, Australia
“These scan changes are normal, just like grey hair”
This is further backed up by the results of a research study investigating the prevalence of degenerative changes (changes due to so called ‘wear and tear’) in patients without low back pain (Jarvik et al., 2001). This study showed that:
- 91% of a pain-free population had signs of disc degeneration (‘wear and tear’)
- 56% had disc height loss
- 64% showed at least one disc bulge
- 32% demonstrated at least one disc protrusion (‘slipped disc’)
- 38% reported at least one annular tear (tear in outer part of a disc)
This was a group of 148 people who had no back pain. Yet the majority of these people had some sort of ‘degenerative change’ or ‘wear and tear’ in their back. This shows us that often, our back pain is not caused by these degenerative changes.
What does cause pain is sensitisation and can in most cases be treated successfully with good Chartered Physiotherapy. For more information please read about ‘what happens when we feel pain’.
It is vital to understand that more often than not there is no need to worry about these kind of scan results; your back is simply undergoing normal change! Remember, your back is one of the strongest structures in your body (O’Sullivan & Lin, 2014). It may be painful and sensitised, but your bones, discs, and muscles are often is pretty good shape! So don’t be afraid to move – relaxed movements should help your pain settle, and allow your back to become stronger (O’Sullivan & Lin, 2014).
By Rachel Neary