What a Pain in the Back

A large number of people suffer from lower back pain (LBP) every year. Figures show 13.6% of the population have LBP right now, and 70-90% of people will experience a period of back pain in their lifetime. This makes back pain a very normal and very common occurrence.

The prognosis for recovery from LBP is generally positive, with most patients having symptoms resolve within the first 3 months following its onset. However, for those patients whose pain persists for out to a year, it is very common that they ask if they need an MRI or x-ray. For most people with LBP imaging is not necessary. In fact, in many cases imaging will not add any valuable information and may lead down a costlier and less effective care path.

How could this be possible? There are a lot of really common findings on imaging such as MRI’s that do not necessarily cause pain. People who are pain free, without any lower back pain or symptoms will often have findings of degenerative disc issues, or disc herniation’s etc. that DO NOT predict future back pain. Increasing age leads to increasing prevalence of the following conditions:

  • Disc degeneration
  • Disc signal loss
  • Disc height loss
  • Disc bulge
  • Disc protrusion
  • Annular fissure
  • Facet degeneration
  • Spondylolisthesis

For example, if you are 50years of age, there is an 80% chance you will have disc degeneration, 60% chance you will have a disc bulge and a 14% chance you will have spondylolisthesis. These findings are shown on MRIs regardless of whether or not you currently have lower back pain.
In our March article Physiotherapy: Spending Money to Save Money, we shared the latest research into the cost effectiveness of Physiotherapy and lower back pain. Physiotherapy can reduce the severity of LBP, improving quality of life, reduce physician visits and sick leave. At Target Physio, we provide patients with one-on-one sessions, with individualised treatment targeted at function and enabling fitness.

Another option available to the community at both our Kenmore and Bellbowrie offices is Clinical Pilates. Although research is limited in the area of Pilates and Chronic Lower Back Pain, studies have shown Pilates can improve pain, disability and physical and psychological perception of health.
So if you are in the 13.6% of the population that are currently suffering from lower back pain, maybe it is time to go see a physiotherapist instead of asking for an MRI or x-ray.  
Figure 2: Jensen M, NEJM 1994
Figure 1: A Disc Bulge in a 21-year-old Man without Back Pain [Jensen M, NEJM 1994]