Before you get an MRI….
We came across a very interesting article recently in the great magazine 'What Doctors Don't Tell You' (www.wddty.com). The piece is by a Dr Mitchell Yass, a physical therapist, and it quotes among other sources papers in the prestigious New England Journal of medicine. In one of the earliest studies to consider conflicts between positive MRI findings and a correlation with pain researchers performed MRI scans on people who had no pain at all. The scans revealed that close to 70% of the people had either bulging or herniated discs.
There are several possible interpretations of this data if you think about it.
- One conclusion would be that MRI scans are not necessarily the 'gold standard' when trying to identify the source of back pain.
- Another possible conclusion is that if nearly 70% of people with bulging discs have no pain at all then on scans of people with pain that pain could be coming from somewhere else! The authors of the study put it this way: 'On MRI examination of the lumbar spine, many people without back pain have disc bulges or protrusions but not extrusions. Given the high prevalence of these findings, and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain my frequently be coincidental'
- Another point worth considering is standard MRI scans are taken lying down in a non weight bearing position. Most back pain is worse in a standing or sitting position.
This is why, as an initial tool, we prefer a standing x ray of the spine to see the overall alignment. Small misalignments low in the spine can, and usually will, lead to muscle imbalances on either side of the spinal column and compensatory misalignments higher up the spine as the body always attempts to keep the eyes level.
We are often asked the question 'so what exactly is causing my pain - is it a pulled muscle, is it a ligament, is it a 'slipped disc', is it muscle spasm?? Given that the body is such an integrated unit its pretty hard to imagine that any pain or discomfort is solely from one structure. Muscles attach to bones which articulate with each other through joints which are held together with ligaments. All have pain sensing nerves. If the spinal column is in optimum alignment and all of its joints and articulating as they should the chances of back pain are surely diminished. So - get your spine aligned and keep it aligned and maybe think twice before you let yourself be rushed off for an expensive MRI scan at the first sign of a back problem.
References: What Doctors Don't Tell You, Oct 2015 p. 62-71
N Eng J Med, 1994; 331 p.69-73