I want to make it known that in order to fix lower back pain and find a real permanent solution, an MRI and an x-ray is not necessary. In fact, I would argue that it actually make the outcomes for the patient worse. On a daily basis, I see people who want and feel they need an x-ray or an MRI so that the healthcare providers that they are working with know exactly is going on. The problem with that thought process is that regardless if you have stenosis, a disc bulge, SI pain (which typically doesn’t show up on an MRI or an x-ray) the idea that an MRI or an x-ray is going to help the provider fix your lower back pain, is false. The reason that I say that is because all three of those lower back conditions ultimately are a result of a bigger problem. The bigger problem is what is actually causing damage to the lower back. I like to use the analogy of an iceberg. What you see above the water is only 10% and below the water is the other 90%
. As we talk more about lower back pain, what we start to realize is it is not the lower back’s fault that it has a disc herniation or SI inflammation or stenosis. It is the areas around the lower back that ultimately aren’t moving properly that are causing stress. All of the conditions of lower back pain are ultimately a stress response. It is damaged tissue. It is stress-caused damage. So yes an MRI or an X-ray helps identify which type of lower back pain you might have, but it doesn’t help you find the treatment or the solution for your lower back pain. In my opinion and what I tell many, many patients that I see is that an x-ray or an MRI should be used as a pre-surgical tool. If all else fails and a surgeon is going to go inside of you, he needs to have an MRI or an x-ray to determine what part of the spine he is going to surgically alter. As you noticed, I didn’t use the word fix because I think the word fix is a relative term. Any and all lower back surgeries don’t fix the problem. They just alter the problem.
Let me share a story of a patient I recently had the opportunity to work with. He was a local physician who had developed severe sciatica and lower back pain on the right side of his body. He was hardly able to walk. He happen to see our advertisement in the local paper for a lower back pain and sciatica workshop (which by the way you can sign up by clicking here). After the workshop he came up to me to tell me his story. He had recently went to his primary care physician who offered him pain medications for his symptoms but he was struggling because legally he can’t take pain medications during his work hours. He also just had gotten an MRI which showed he had a disc bulge on the left side of his spine. He then had a consult with a neurosurgeon who recommend he have surgery immediately. In fact he was actually scheduled for surgery in the next coming week. His question to me was how could a disc bulge on the left side of his spine cause pain down his right leg and in his right lower back. The answer I had for him was it CAN’T. He was almost relieved with that answer. Being a physician he was almost emabarrased that he didn’t know the answer or believe the neurosurgeon. But deep down inside he knew that it was not possible and that it didn’t feel right to have surgery. So he committed to 15 visits of physical therapy and every visit he began standing up straighter, walking without pain and finally was and is pain free. His big limitation was actually his hip mobility which was causing increased stress in his lower back. His disc bulge had nothing to do with his problem.
If you also look at the statistics and the research behind MRIs specifically for disc herniations, what they show is that 60% of people that are given an MRI for any reason will have a disc bulge or disc herniation. But only 10% or those people have pain. So what that means basically is that the MRI often times can actually confuse the provider and make somebody think that they have a disc herniation or a disc bulge when ultimately the pain is not coming from that. We also know that there is a huge cost with MRIs. The average MRI is over $2,000 and they are only typically valid for less than a year. They really just don’t help as much as we think that they help. I would even argue that there are health providers such as Physical Therapists, Orthopedic Surgeons and Physiatrists that know what are called orthopedic special test which are movements or positions that you put a person in which tells you what the condition actually is. And research has shown a high level of specificity and sensitivity that these tests can indicate what the source of the lower back pain is or the type of lower back pain that somebody has. For instance, if I have somebody who I believe has stenosis in the lower back I can give them a verbal questionnaire which has been proven to be 97% accurate. The questionnaire asks: #1. Are you over the age of 55? #2. Do you have lower back pain with standing and walking? #3. Does your lower back pain go away with sitting? If you answer yes to all 3 of these questions, then there is a 97% chance that you have lumbar stenosis.
That has been proven by research. That is actually more accurate than an MRI or an x-ray. We also know that testing for disc herniations and disc bulges would include a test called a Straight Leg Raise or a Dural Stretch Test which stretches the Sciatic Nerve. If that is a positive test, there is a 90% chance that the person has a disc herniation or a disc bulge. We also know that just asking the patient, do you have increased pain down your leg with coughing, laughing or sneezing? Those are very strong indicators that a person has a disc herniation or a disc bulge and is much more accurate than an MRI.
The above test can be found here: http://thesuperiortherapy.com/category/video-learning/self-tests/.
I often have patients who come in with imaging. They tell me their symptoms and their symptoms don’t fit with the image they have in their hand. You have to disregard the x-ray and the MRI which becomes a waste of money and a waste of time. Being confident that research shows that the image may not be true is very important. Trust me, I have seen this happen hundreds and hundreds of time in the past. But yet every patient that comes in the door feels that they need to have that image. So I’m here to tell you that the MRI and the x-ray often times are lying to you. It is not the most accurate way to identify lower back pain and find solutions. In fact, it helps nobody find a solution. It just helps you categorize an individual and tell them what the structural damage is. But it does not tell somebody what to do about it, what the cause is, or what the treatment should be. It is ultimately a tool that should be used only when somebody is about to have surgery so that the surgeon knows the exact level to go to when he is going to alter the structure of the lower back.
I think that it is important to understand that MRIs and x-rays have a purpose. But it is not the purpose that you probably believe. I’m here to tell you that you should trust the health provider that you are working with. And if they don’t feel that you need an MRI or an x-ray than that should be the advice that you follow. Because you could end up spending way more money and way more time than you really should be in the first place. And ultimately it just categorizes you and it does not find a permanent solution.
We are hosting a lower back pain and Sciatica Workshop coming up very soon and we have a few seats available. If you would like more information click here.
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