Back pain & MRI scans – discussing the prevalence of spinal degeneration in asymptomatic individuals
MRI technology is an accurate method of measuring degenerative changes in the spine.
It provides clear images of the soft tissue deep inside and is with no doubt a great tool for diagnostics when it is needed.
What we need to keep in mind however is that spines commonly look worse than they are! And diagnosis that are mainly based on what a scan indicates can often be quite misleading since what’s being shown, does not necessarily mean that being the rooting cause of someone’s pain.
An interesting Systematic review by Brinjikji W. et.al (2014) presented how common degenerative spinal changes are amongst all ages in people that are asymptomatic!
Results from this are presented in the table below.
As we can see, 37% of people in their 20’s with no back pain had “disk degeneration”.
40% of people at the age of 30 with no back pain presented having “disk bulge”.
By the age of 50, the number for “disk degeneration” was increased to 80% and the amount of “disc bulge” for this age group was shown to be 60%. Note that all these people reported being pain free.
This just goes to show how complicated and multifactorial low back pain is. MRI results are just one piece of the puzzle amongst the many possible factors that may be contributing to pain so we cannot reliably diagnose low back pain with scans in isolation, can we?
Our spines are strong and stable structures, able to withstand and generate large amounts of force. Yes, it sure is complex and tricky to understand! But it is capable of producing remarkable movement and we should not underestimate its ability to heal.
About 85% of people will deal with low back pain at some point in their lives. It is important to understand that majority of back pain is due to strain or sprain injuries, and recovery can be accomplished around as short as 6 weeks for 70- 80% of people if following a safe and appropriate treatment plan.
When low back pain has been over-medicalised and a fancy term diagnosis has been set to the cause, the situation for those people suffering often worsens and they become significantly more anxious and fearful for the future. At the same time, they commonly receive different instructions from health practitioners with opinions advising what they should and should not do… which can be very confusing for someone who is already in a heightened emotional state trying to cope with their pain to get through the acute stage. Of course, this person will start to worry more. Sadly, it is commonly seen that people develop a fear-avoidance behaviour from these situations which further leads to inactivity and may delay recovery time.
Keep in mind that a person’s belief and attitude significantly impacts the potential recovery in acute stages and the levels of success in management of chronic pain and disability.
Research has shown that many low back pain sufferer’s experiences a reduced sense of well- being following exposure to an MRI scan and psychosocial factors often presents which commonly leads to poor adherence to treatment plan and lack of motivation returning to work or recreational activities. High levels of anxiety, depression and substance abuse is a large problem amongst low back pain patients which also can result in symptoms worsening.
Seeking help and receiving treatment from a trained professional in Exercise Physiology or Physiotherapy in the early stages is therefore highly important. In most cases, conservative management that prescribes individualised exercise programs addressing stability, mobility, flexibility, and strength can help alleviate pain as it effectively reduces stress on the spine.
If you are living with back pain, we recommend that you to reach out to a professional. Exercise Physiologists and Physiotherapists does not only aim to assist you in the acute phase, but also to teach you how to manage the underlying issue and prevent reoccurring events. This to overall set you up with good self- management techniques in order to live a healthy and pain free life.
Written by Accredited Exercise Physiologist, Therese Sioestroem
Brinjikji, W., Luetmer, P., Comstock, B., Bresnahan, B., Chen, L., Deyo, R., Halabi, S., Turner, J., Avins, A., James, K., Wald, J., Kallmes, D. and Jarvik, J., 2014. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), pp.811-816.