If I were to show you a picture of a cell phone, could you tell me if the phone was ringing just by looking at the picture? Of course not! Identifying back pain with an MRI is very similar. We can’t identify the cause of low back pain by looking solely at an imaging image such as an MRI or X-Ray. A recent study studied a patient with chronic low back pain by watching the person get ten MRIs in ten different facilities throughout a three week period. The study found that throughout all ten reports, there was no single finding (1).
Imaging is a valuable tool to identify the current state of the lumbar spine, but it is only a snapshot of the spine. All patients who have imaging completed would have objective findings such as degenerative joint disease, osteoarthritis, or a herniated disc, but in most cases do not have pain.
Two-thirds of adults will be affected by low back pain (LBP) at some point in their lives. Of those with LBP, seventy percent can be classified as “non-specific LB P”. This means a true specific source cannot be identified. At this point pain itself becomes a limiting factor and not a structural abnormality. Most of these acute episodes of LBP show measurable improvement in pain and function within the first four weeks. For LBP with pain down the leg (radiculopathy), most resolve within weeks or months (2). A common cause of these radiculopathies is a herniated disc.
On a regular basis, I see patients who report that the cause of their chronic LBP is a herniated disc or discs that were diagnosed in the past. However, a recent high-level study indicated that 67% of the herniated discs reabsorb or “de-herniate” by themselves (3). If most LBP improves in a short period of time, why spend the time going through the costly process of imaging? Why not go straight to physical therapy that will speed up the recovery process and get you back to a quality of life you can enjoy.
We know abnormalities in lumbar imaging are common to pain-free people. We cannot directly correlate the abnormal findings as being responsible for pain. Early imaging of low back pain may actually lead to worse outcomes. One study showed there were eight times the risk of surgery and five times more cost when an MRI was ordered within the first month of LBP (2).
Low back pain imaging can be a useful tool but it is not a full picture. The abnormal findings on low back pain imaging are found in most pain-free people and in many cases cannot be correlated to the cause of pain. The conversation for the treatment of low back pain should always start with conservative care options such as physical therapy. Always discuss your specific treatment options with your healthcare professional.
If you suffer from back pain, physical therapy can help you get back to doing the things you love without pain. Contact one of our clinics to schedule an appointment.
Herzog R, Elgort DR, Flanders AE, Moley PJ (2017) Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations of the same patient within a 3-week period. Spine Journal,4, 554-561
Wang Y, Wu A, Ruiz Santiago F and Nogueira-Barbosa M (2018) Informed appropriate imaging for low back pain management: A narrative review. Journal of Orthopedic Translation, 15,21-34.
Zong M, Tao Liu J, Hong J, Mo W, Xiao R, Yu P (2017) Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician,20, E45-E52.