When the MRI isn't everything
I've heard this more times than I care to admit. Lower back pain is probably the most common thing I treat. Often times the patient suffers some culminating instance where they really tweak their back. They get an MRI. And the MRI says they have a herniated disc. The come to my office and say:
Dr. Mike, now what?
Now Keep Moving!!
When I talk with patients, friends, family members who all tell me about their MRI and how “bad” their back is, I’m always disappointed to hear that they’ve cut back or even completely stopped working out.
“I stopped exercising because my MRI results show moderate disc degeneration in my lower back and my doctor told me it could make my back worse.”
Pain, especially in your back, can be frustrating, annoying, and depressing, and when your MRI results come back with structural damage, it can seem even worse.
However, as the medical community continues to do more research, we’re beginning to learn that the findings on an MRI don’t always correspond with your symptoms or pain! There’s been numerous studies done, with MRI’s performed on asymptomatic populations, that showed severely herniated discs and advanced disc degeneration. Similarly, there’s been studies done on patients who have very real pain, but their MRI is completely clean!
Interested in a Lower Back Pain Seminar?
Why Mike, WHY am I in pain then!?
Pain is a very complex, multifactorial experience that involves a lot more than just what your MRI says. Pain is a feeling we experience, which means it’s an output from our brain.
The International Association for the Study of Pain defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in such terms.”
Now, I’m not saying the pain is in your head, it’s definitely VERY REAL, no doubt about that!
What happens, is in the body part that you injure, there are these little receptors, called nociceptors, that detect changes in tissue. They then send a message to your brain saying, “Hey, somethings off here”. Your brain then interprets that message and gathers a whole collection of other info, including but not limited to- current situation, force of tissue change, current stress level, diet, sleep, personal/family beliefs about pain- and then in an instant will send a message back to that original area, either sending a feeling of pain or “eh not a big deal, just carry on with your day.”
Here is a great video from International Pain expert, Lorimer Mosely, entitled “Why Things Hurt”.
Ultimately, I’m not trying to say that diagnostic imaging is useless, it can be extremely important in helping to rule out other serious red flags, as well as in rule in diagnoses. In my opinion though, as rehab and medical professionals, we need to do a better job at educating our patients and changing the narrative, just because you have a “herniated disc” or “disc degeneration” doesn’t mean you’re broken!
Outcomes for patients with lower back pain who continued to move and be active after injury are significantly higher than those that were prescribed bedrest. Now I’m not saying continue to do the same exact things that are making your back painful. What I am saying is talk to a rehab professional about what you can do to move better and pain free. We’re experts in movement and well versed in terms of pain education, tissue loading, and gradual exposure to exercise.
If you’re interested in talking with a Doctor of Physical Therapy about what you’ve been dealing with, you can contact Dr. Mike right HERE