When it comes to the public’s understanding of back pain, few words are as frightening as this one: DISC. Many people are led to believe that if they have a disc herniation somewhere in their spine, their backs will never be the same. HA! This could not be further from the truth. Let’s look at the pooled evidence shall we?
Brinjikji et al (2015) compiled the research of MRI findings in people WITHOUT back pain, and here’s what they found. Disc bulges occurred in 30% of 20 year olds, 60% of 50 year olds, and 84% of 80 year olds. Notice anything there? That’s right, the prevalence of disc bulges increase the older you get. (Remember, these people are pain free!) So MAYBE that disc ‘problem’ your doctor told you about has nothing to do with your back pain, and is simply a normal part of living and ageing. This is good news!
More good news: disc injuries heal! Chiu et al (2015) pooled the available data on disc herniations in the lower back and discovered that 96% of disc sequestrations (i.e. the largest and most serious type of herniation) SPONTANEOUSLY regress and 43% COMPELTELY RESOLVE ON THEIR OWN. These outcomes were far better than any other kind of herniation, so the bigger the disc injury the more likely it will improve. Pretty awesome.
Now, getting back to MRIs and disc bulges. I’d be remiss to suggest MRIs are USELESS when determining associated links in back pain. To check my own bias, another study by Brinjikji et al. (2015) found a greater prevalence of disc degeneration in those WITH back pain than those without. Confused much? You’re probably thinking: how am I supposed to know if my disc bulge ACTUALLY has anything to do with my back pain? Thankfully there are these awesome health professionals called physiotherapists—we can determine if there is any correlation or not. Come find us.
- The prevalence of disc bulges naturally increases across the lifespan (and they may have nothing to do with your back pain). THEY ARE NORMAL!
- The most severe type of disc bulge heals spontaneously, and it heals the best.
- Don’t ever rely on an MRI alone to determine the cause of your back pain.
Nick Hannah, PT
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- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015. 36:811-16.
- Chiu C et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehab. 2015. 29(2)184-195.
- Brinjikji W et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. Am J Neuroradiol. 2015. 36:2394-99.