Back pain and imaging
You are NOT defined by your imaging
Low back pain in one of the most prevalent complaints and affects up to 80-85% of the population during their lifetime [1]. In fact, back pain is associated with high health care costs and has considerable economic consequences due to loss of productivity from back pain-associated disability [2]. Advanced imaging such as computerised tomography (CT) and magnetic resonance imaging (MRI) are often used in evaluation of people with low back pain. Imaging findings, such as disc degeneration, facet hypertrophy and disc protrusion are often accused as culprits of low back pain, prompting both medical and surgical interventions, which are often unsuccessful in abating symptoms.
Pain is incredibly multifaceted and more complex than a picture of your anatomy. In fact, a recent systematic review suggests that many imaging-based degenerative features (i.e., disc degeneration, disc protrusions and disc height loss) are considered part of the normal aging process, like grey hair or wrinkles and are present in high proportions of asymptomatic healthy individuals. Within the review, the authors analysed the results of imaging findings from 3,000 individuals with no history or present complaint of back pain. The finding that > 50% of asymptomatic individuals 30-39 years of age have disc degeneration, disc height loss or disc bulging indicates that even in young healthy adults, degenerative changes may simply be incidental and not necessarily be influencing reported symptoms [3]. These percentages continue to rise by approximately 10% with every decade as depicted in the table below. Absolutely mind-blowing right?
Evidence now suggests that imaging is useful only in the small subgroup of people where there is suspicion of sinister pathology. This includes cancers, infections, inflammatory disease, fractures and severe neurological deficits which accounts for only 5-10% of low back pain presentations [4]. To put it another way, for 90-95% of uncomplicated low back pain cases, imaging will not necessarily change or influence the management plan and can actually cause more harm than benefit thereby prolonging recovery. Fear, anxiety and reluctance to move can begin to set in and disrupt your normal activities of daily living.
When clients present to Ferry Rd Physio with low back pain, your physiotherapist will meticulously ask a series of questions regarding your symptom onset, behaviour of symptoms, past medical history and overall general health. Thereafter, a thorough physical assessment is performed taking into consideration all the pertinent information provided. From this assessment, if there are any indications of concerning pathology or “red flags” for which additional information would be beneficial, referral for imaging may be recommended.
In brief, your low back pain generally has a favourable outcome in spite of how terrifying your imaging results may appear. Remember, you are not defined by what the X-rays, CT scans or MRI results say. Your back is a strong, stable and robust structure!
References
- Murray, C. J., & Lopez, A. D. (2013). Measuring the global burden of disease. New England Journal of Medicine, 369(5), 448-457.
- Deyo, R. A., Cherkin, D., Conrad, D., & Volinn, E. (1991). Cost, controversy, crisis: low back pain and the health of the public. Annual review of public health, 12(1), 141-156.
- Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
- Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009 Oct;60(10):3072-80.