First things first; YOU ARE NOT YOUR SCAN. Every injury is as individual as the person who carries it. In the majority of cases of low back pain, there is no need for x-ray or MRI imaging at all.
There are only 3 reasons a health professional should be ordering scans for your back;
- There’s a history of significant trauma (i.e. a car accident, fall from a horse, knee to the spine) to rule out fractures and other serious internal injuries.
- You present with “red flags”- this would be a weakness in the legs, burning pains or numbness down the legs, loss of bowel or bladder control or a history of cancer
- You don’t respond to treatment as we would typically expect or your clinical presentation just doesn’t quite make sense
When we scan a person we also commonly find “false positives”. These are a little like ‘red herrings’ – they technically exist but aren’t the cause of your pain. In fact, there’s been a massive amount of study in this area… have a look at the results of this study by Waleed Brinjikji and his team from 2015. They did this amazing study where they reviewed studies that scanned over 3000 people who have NO BACK PAIN whatsoever.
Age-specific prevalence estimates of degenerative spine imaging findings in asymptomatic patients:
| Age (yr) | |||||||
| Imaging Finding |
20 |
30 | 40 | 50 | 60 | 70 | 80 |
| Disk degeneration | 37% | 52% | 68% | 80% | 88% | 93% | 96% |
| Disk signal loss | 17% | 33% | 54% | 73% | 86% | 94% | 97% |
| Disk height loss | 24% | 34% | 45% | 56% | 67% | 76% | 84% |
| Disk bulge | 30% | 40% | 50% | 60% | 69% | 77% | 84% |
| Disk protrusion | 29% | 31% | 33% | 36% | 38% | 40% | 43% |
| Annular fissure | 19% | 20% | 22% | 23% | 25% | 27% | 29% |
| Facet degeneration | 4% | 9% | 18% | 32% | 50% | 69% | 83% |
| Spondylolisthesis | 3% | 5% | 8% | 14% | 23% | 35% | 50% |
That’s right, 37% of all people in their 20’s WHO DON’T HAVE PAIN will have ‘disc degeneration’ on imaging, and 30% have a disc bulge! The conclusion from the study was that ‘Many imaging-based degenerative features are likely part of normal aging and unassociated with pain’
This brings me back to my initial statement… you are not your scans! The next step is to MOVE more and build your back’s load capacity. The more your back moves and the stronger your back is, the happier it will be. There is no one size fits all in the approach to doing this, but one thing’s for sure…If an activity or exercise doesn’t give you pain or make your pain worse it’s probably GREAT for you.
If you need specific advice on improving your back pain and (more importantly) getting back to doing the things you love to do, then please get in touch: we’d love to help you out!