This Will Shock You: Do Scan Results Explain Your Lower Back Pain?

Do your scan results tell you the whole story of your pain?

When it comes to lower back pain, scans like MRI, X-ray, and CT scans are often used as crucial diagnostic tools. These scans are incredibly useful in giving us a peek inside our bodies. They help to diagnose specific issues like herniated discs, spinal stenosis, or fractures. But are the results of these scans telling the full story of your pain? A huge 2015 study tried to answer this question and their results will surprise you.

But first, let’s explore what each of these scans is best at.

The Big 3 Scans For Lower Back Pain - X-rays, MRI and CT scans

An X-ray is often the first step in spinal imaging. It's a good tool to help visualise the alignment and structural integrity of our bones. If you have any breaks or big changes in your bone alignment an X-ray will be able to tell you. However, X-rays are not effective in visualising soft tissues such as muscles and nerves.

If we want a more detailed look at the soft tissues in our body (think muscles and nerves), we turn to MRIs (Magnetic Resonance Imaging). MRIs provide in-depth images of both bones and soft tissues and are great at identifying specific conditions such as herniated discs, tumours and stress fractures.

In some cases, a CT Scan (Computed Tomography) is used. This technique combines X-ray with computer technology to produce cross-sectional images of the body part being assessed. These cross-sectional images can be reformatted into three-dimensional images, providing rich detail of the scanned body region. CT scans are often used for lower back pain to identify complex fractures, arthritic changes of the lumbar vertebrae, and lumbar spinal stenosis.

With technological improvements in the last half a century, the quality and accuracy of the images these scans produce can’t be questioned. However, a 2015 study did question the importance of the results found on these scans. The researchers asked the question: how common are lumbar spine degenerative changes in people WITHOUT lower back pain? Their theory was that even in people who have never had lower back pain before there would be some degenerative changes found.

What they found even surprised them. KEEP READING.

DO PEOPLE WITHOUT LOWER BACK PAIN HAVE DEGENERATIVE CHANGES?

Their study was huge. The researchers conducted a meta-analysis, a type of research study that analyses the results of separate studies on the same topic to identify trends in the data. They analysed 33 previously conducted studies, with a total of 3110 participants. The main condition for people to be included in this study was that they had to have no previous episodes of lower back pain.

The researchers had 2 main goals: first, to find out how common it is for people without lower back pain to have common lower back pain degenerative condition findings on a scan. And second, to find out how these degenerative conditions change as a person ages.

So what did they find?

The researchers found that in these people without any history of lower back pain, not even a single day, they had degenerative changes on their lumbar spine scans. On top of that, they found that in all the conditions they assessed for, the percentage of people with these lower back changes increased with age. Below is a table of their findings.

What really stands out is how common these degenerative conditions are in people in their 20s. The four findings in particular were:

• Disc Degeneration: The prevalence of disc degeneration in asymptomatic individuals increased from 37% in 20-year-olds to 80% in 50-year-olds

• Disc Bulge: Disc bulge prevalence rose from 30% in 20-year-olds to 60% in 50-year-olds.

• Disc Protrusion: The prevalence of disc protrusion went up from 29% in 20-year-olds to 36% in 50-year-olds.

• Facet joint degeneration: 4% in 20-year-olds and 32% in 50-year-olds

I am pointing out the 20s and 50s brackets because I want to highlight how common these changes are in people under 60.

But why is this so important? Why do the findings of this study question the importance of lumbar spine scan results?

This study highlights that these lumbar spine degenerative conditions are found in people without any previous lower back pain. On top of that, they become more common as a person ages. The fact that all conditions become more common as a person ages suggests that these lower back degenerative changes are a normal human aging process.

And that makes sense. Nothing is made to last forever. It is only natural that there are signs of aging the older we get. Just like we get grey hair and wrinkles on the outside, perhaps these changes are the grey hair and wrinkles on the inside of our bodies.

IF LOWER BACK DEGENERATIVE CHANGES ARE NORMAL, WHY DO I STILL HAVE PAIN?

In my experience, people with lumbar spine degenerative changes can function normally without lower back pain. The reason you still have pain is because your lower back is doing too much work during your daily life. The key to reducing the load on your lower back is to start a rehab program that addresses the key mobility and strength deficits found in lower back pain, and then gradually build up your tolerance to regular activity.

As a physiotherapist, people are often referred to me with diagnoses of disc degeneration, disc bulges, disc protrusions, or facet joint degeneration. But these people have been given their diagnoses without a full assessment being conducted. Seeing any scan results out of context will set off alarm bells. The fact that 30% of 20-year-olds walking down the street have a disc bulge suggests that most people getting a scan will find something they should be ‘worried’ about.

The key takeaway from this study is NOT that scans are useless and we should completely rule them out. In fact, I commonly use scans in my practice. Scans, paired with a thorough movement assessment are a great tool in the diagnostic process. The key takeaway is that lumbar spine scans by themselves don’t tell the full story of someone’s symptoms.

With the right rehab program, you can have any one of these degenerative conditions and function WITHOUT pain.

If you have scan findings that are troubling you and you want to start your journey towards being pain-free click here. Or if you want to start exercising but you’re not sure how to fit it into your busy schedule read this article.