Pinched nerves, herniated discs, arthritis, stenosis. All scary words, along with other scary-word friends that get thrown around a lot to describe back injuries.
These diagnoses are typically associated with an assumption that your pain is permanent. You’re reading this because you’re not going to fall into that trap!
If you want to believe that your back pain, no matter what imaging shows, doesn’t have to last forever, then you should keep reading. If you like the idea of forever pain…then I guess you shouldn’t waste your time here.
A picture cannot tell the story
A picture may be worth a thousand words, but an internal image of your body can’t tell much of a coherent story. At least not when it comes to musculoskeletal pain.
I’ve used this quote by Dr. Stuart McGill, a renowned spine researcher, before, and I’m going to use it again:
We have found that a thorough assessment reveals the cause of pain better than any image.
Why does he say that?
There are certainly many reasons, but the best one is simply because it’s true! Pain and image results are not well correlated. Let’s take a look at a few examples from the research.
To the research!
One group concluded their research, “There was not a clear relationship between the MRI appearance of the lumbar spine and low back pain.”
The data from this same research study showed that 32% of the participants without pain showed ‘abnormal’ spines on the image. So based on the image, their physicians would have been pointing to their degenerated discs, arthritis, nerve root compression, and/or disc herniations to explain the source of their pain…except they didn’t have any pain.
On the flip side, 47% of the participants in the study who had pain showed normal spine images. The conclusion from looking at the image was that there was no significant issue in the spine, and so there shouldn’t be any pain…except there was.
Another group performing a review of multiple research studies involved with diagnosing low back pain offered this little tidbit:
It has been proved that MRI has no major benefit for diagnosing low back pain in the patients with degenerative diseases. According to the recent studies, early routine imaging (x-p, CT, and MRI) has no apparent benefits.
Why does imaging for back pain have no apparent benefits? Because in this case, a picture just can’t tell the story.
“Squeezing and pulling” on nerves
Let’s look at one specific example to bring our discussion to real life.
A “pinched” nerve is sometimes diagnosed based on an image showing a large disc herniation or foraminal stenosis. It may even be given as your diagnosis simply because you have pain running down your leg.
Pinched nerve is a bit of a misleading term and the general methods to diagnose this pathology, as mentioned above, are quite poor. Now let’s dig into why this isn’t a doomsday diagnosis.
An incredibly daring study was performed that gave us some great insight. During surgery, they sutured up the patients’ nerves in such a way that allowed them to pull on the nerves when the patient was awake.
How crazy is that!
They squeezed and pulled on those nerves, and not surprisingly, some patients experienced severe, lancinating pain. Glad I didn’t sign up for that study.
Here’s the interesting part: only the patients that had inflammation at the nerve had the pain with squeezing and pulling. To quote a commentary on the article:
“Significantly, squeezing or pulling normal nerve roots does not
produce radicular pain. Only if nerve roots have previously been
inflamed does mechanical stimulation evoke radicular pain.” — N. Bodguk
So what does this mean for us?
What scabs and your back pain have in common
Let’s turn to an analogy for help.
When you have a large scab after an injury, it’s generally best to leave it alone. As you do, the insult desensitizes (no longer painful), and heals.
If you pick at it constantly, it will get inflamed and keep bleeding and scabbing and can progressively get worse. Infected and other bad stuff.
I want you to think of spine injuries in a very similar manner. If you pick at the scab constantly, inflammation will hang around and the injury remains sensitive, or painful.
If you leave it alone, the injury will desensitize; it no longer causes pain.
The things that “pick at your scab” with your spine injuries are what we refer to as triggers.
It’s harder to know what your triggers are for your spine pain, and that’s what we’ve become the best at. You have to identify and eliminate your triggers.
That stops the scab picking, which stops the inflammation at the disc and nerves. Remember that crazy study we just summarized above?
Normal nerves without inflammation did not produce the expected pain response when intentionally squeezed and pulled.
Stop picking the scab, no more inflammation, no more pain; even if the image shows structural problems!
I’ll add one more element to the scab analogy, then I promise I’m done with it.
If the injury is severe enough, that scab can lead to a scar. The scar is no longer painful, but you still see the structural evidence of an injury. The same thing happens in your spine!
Images cannot tell the story of your spine pain. Your pain and symptoms tell the story of your pain. And you can get out of that pain, just like you expect to do when you cut your skin.
Why should our expectations be any different with our spine?
Maybe that just applies to everyone except me
When you have been experiencing pain for a long time, it’s easy to think, “I am something different. Every medical person who has looked at me tells me they’ve never seen anything like me. I don’t think my pain can be solved.”
Oddly enough, I hear this pretty often, at least once a week. It’s actually one of my favorite things to hear because I can’t wait to see the impossible come true.
When you come to understand what is triggering your pain (picking at the scab), and how to stop it, healing happens.
There certainly are cases where pain might not resolve with physical rehab, usually due to certain traumas or systemic diseases. Even in these situations, strategies can be implemented to better manage the pain and improve quality of life. And these cases are more rare than common among the spine pain patients I treat.
You expect your body to heal when you get a cut or a scrape, even if it’s a really bad one. But that’s because you know how to manage it.
You protect it and leave it alone so it can desensitize and heal.
Now we all need to look at spine injuries the same way. The same body that heals your open wounds can heal your spine insults, it just needs some time and help to desensitize and heal!
Identify what triggers your pain, eliminate the triggers, and be amazed at the healing that happens. If you can’t figure out what triggers your pain or how to eliminate it, search until you find a professional who really can.
Don’t give up! I hope you believe me now: you are not doomed to have pain forever.