Back Pain

Beat Your Back Pain

I’ve had an MRI on my back and have the results. What does this mean?

Low back pain can be a sudden and scary experience. It can affect simple everyday activities that we often take for granted. Fortunately, you are not alone. Many people experience low back pain – in fact, up to a quarter of Aussies are affected on any one day. We see it regularly in our clinic.

You might have already seen your GP and been referred for an MRI scan. MRI’s (Magnetic Resonance Imaging) can be a great tool to help identify structural changes that may explain your pain. But interpreting the results report can be overwhelming and confusing. You might see words like ‘disc degeneration’, ‘disc bulge’ and ‘disc height loss’ floating around. What do they mean? What implications do they have for you?

The changes that you see on your MRI give us a glimpse into how your back has adapted to load over time. Often, this is not a bad thing. It is how your body helps you perform your everyday activities and function better.

Why does my back change?

Let’s take a bicep curl at the gym, for example. If you use progressive heavy weights to do bicep curls, then over time it will get bigger and stronger. Your biceps muscle adapts to the heavy load you have put on it, and changes its structure, so that next time you can tolerate that weight and lift even more.  It’s potentially a similar situation in your back.

Your MRI will show how your back has adapted to load over time.

Let’s say you are a carpenter. On your feet all day, lifting, bending, the works. You are right-handed and bend over to the right side more than the left. The structures in your back will adjust for this – the right side of your disc may become thicker to add more support. Your discs adapted to more load on the right so that you can continue to use your right hand. Now when you get your scan, it may note ‘hypertrophy’ on the right, or ‘disc height loss’ on the left. It doesn’t mean that this is the cause of your pain. It was just a change that your body made over time.

Ready for technical made easy??

A little crash course on the technical terms…

There is a disc between each bone in your spine. Your disc is made of a thick outer ligament layer (annulus fibrosis) and a softer squishy gel inner layer (nucleus pulposus). They are held to the bones (vertebrae) by a cartilage substance called an endplate.

This is a nifty little design. It allows you to move and absorb forces. When under compression, the soft layer is designed to absorb the pressure and is held in place by the strong ligament layer. Over time the body is great at adjusting to repetitive loads to meet day to day demand. In the case of our carpenter, it could simply be that more of the gel-like structure is required on the right. The outer layer may adjust for this and push beyond the boundary. Consequence – the MRI reads ‘disc herniation’.

Am I Normal

In fact, you might be surprised to know that many ‘scary’ MRI findings are very normal! In fact, they are commonly found in people with no low back pain at all.

One systematic review analysed the MRI findings of 3000 asymptomatic people of all ages (Brinjikji et al., 2015). They found that 50% of 40 year old’s had signs of a disc bulge on their MRI, despite having no low back pain. 37% of 20 year old’s showed signs of disc degeneration, yet were able to continue their daily activities without limitation.

Table 1 below highlights the percentage of asymptomatic people with degenerative MRI findings.

Table 1. Age-specific prevalence estimates of degenerative spine imaging findings in asymptomatic patients (Brinjikji et al., 2015).

Key message: MRI findings like these are often very normal and not signs of ‘damage’ or pain. They simply show us how your body has adapted to load over time.

If this is normal why am I in pain?

So you might be thinking – hang on. You’re telling me that I have pain in my back and down my leg, but this scan is normal? There is some clinical judgement that goes on here. Sure, a lot of adaptations are considered ‘normal’ on a scan. However, when we do a certain movement (often under unexpected speed or load) that our body has not been primed to adapt to, this system might sense it can’t handle it and cause a “danger alarm” response, aka pain. That is when you often experience symptoms. This may show on your scan. But it is not to say that all findings are relevant to what you are feeling.

MRI findings are only significant if they correlate with your symptoms – a clinical assessment performed by your physiotherapist can help determine this.

Are my MRI findings ever bad?

Yes – in fewer than 10% of sore backs with MRI findings they can be serious and require very specific management.  If not sure send me a message with your report and see if we can help.

So what does this all mean for me?

It is also important to keep in mind that once we clear out nasty diagnoses, our management of your back pain is not based on the scan, but rather by your movement. We look at the individual in front of us, not just a black and white image.

We get to understand YOU and how we can get YOU moving better.

  • Why you move like you do? Why your body has changed the way it has?
  • What you want to do if you did not have back pain?
  • What barriers are in the way of achieving that?
  • Create a plan that is specific to your body and your goals

It is our job to put both parts of the picture together. We want to know what is going on in your body and help you to better understand that. The last thing we want is for you to worry about certain findings on your MRI that are completely normal and not the direct cause of your pain. Fixing the scan does not necessarily fix you.

Our aim is to get you back to where you want to be and create a targeted specific management plan to help you achieve your goals.

If you have any questions or find yourself to be in a similar boat, please do not hesitate to book in or send me a message.

Woman Lifting Dumbbell
Man Running On Road

B.App.Sci. (Phty)

Physiotherapist

Maya Patel is a physiotherapist with a special interest in knee and ankle injuries stemming from her passion for netball and football.

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