It’s time to write this.
Here’s what I have to say.
I don’t care about your herniated disc. Or your torn labrum. Or the arthritis in your neck. ~Me
Please don’t take this to mean that I don’t care about you or the sufferring you’re going through right now.
It’s just that I don’t care what your fancy pictures (x-ray or MRI) look like or what you’ve been diagnosed with by someone else.
All of this “not caring” talk is somewhat facetious. The fact that the structure of your body is not ideal does tell me something about your body. However, it’s one small piece in the puzzle.
The Research on Herniated Discs
In a 1994 study by the New England Journal of Medicine, researchers sent images of 98 “healthy” (no symptoms) backs to two neuroradiologists, asking for a diagnosis.
Only 36% of the SYMPTOM-LESS individuals had clean MRIs. That means no herniations (see the red and green arrows in the image above), sequestrations, extrusions, dragons, or monsters present.
52% had a bulge at least one level.
27% had an extrustion.
1% had an extrusion.
Conclusion: 80% of healthy and symptom-less individuals had MRIs that a doctor diagnosed as a problem.
Let me summarize the research: I don’t care about your “herniated disc.”
What Does An MRI Do?
In a report done by the Radiology Society of North America in 2007, imaging has two roles.
- provide accurate morphological information (what the structure of the spine looks like)
- influence therapeutic decision making
No one denies that imaging such as MRIs successfully accomplish #1.
The problem is with #2.
“Any study looking at the natural history of degenerative disk disease, prognostic value of imaging, or its effect on therapeutic decision making will be confounded by the high prevalence of morphologic change in the asymptomatic population.” [the boldness is mine.]
The MRI is very successful at taking a picture of the joints of the body.
Again, this is only a small piece of the puzzle.
As a small piece, I normally refer out for an MRI in these situations:
- when treatment is going nowhere.
- serious trauma to the low back.
- lower extremity numbness/tingling that is not provoked by musculoskeletal movements.
- lower extremity numbness/tingling/weakness that has lasted more than a month.
- serious “saucerization” of the low back (more on this in another blog post. “Saucerization” is a fancy way of saying that the lumbar spine has been damaged and the muscles at specific levels won’t relax and stretch, either due to spasm or adhesion.)
In the above cases, an MRI can help let the doctor know if treatment should begin/continue or if surgery is the right solution.
Here’s What I Do Care About
Conventional wisdom tells you this equation :
Your symptoms (PAIN) + Your images (MRI) =
- “Don’t squat” OR
- “Don’t exercise” OR
- “Don’t live your life” OR
- “Let’s cut you open” OR
- “Here, take these highly addictive painkillers.”
This equation is merely a moment in time.
At this moment in time, you’re in pain with a certain amount of structural change to your body (as evidenced by the MRI). The “answer” part to the equation is trying to protect you based on what conventional wisdom knows. Doing specific movements will only increase the amount of pain and damage done to the structure of your body.
But come on. How are you supposed to use the toilet bowl when the doctor says you’re not allowed to squat?
I care about these factors:
- the amount of bubble gum (or scar tissue) in between your muscles, ligaments, nerves, and tendons.
- the strength, endurance, flexibility, and stamina of your muscles.
- the amount of inflammatory foods you are consuming, such as grains, dairy, and processed foods.
That bubble gum that God put in your body is directly responsible for your muscle inflexibility and indirectly for your relative muscle weakness. [ie. When you squat, you can’t stand back up.]
For scar tissue help, find a proficient Integrative Diagnosis provider , Active Release Technique provider or Graston provider. It is my personal opinion that an Integrative Diagnosis provider is the best musculoskeletal pain specialist that you can find. (Dr. Brady, founder of the “Integrative Diagnosis” curriculum, demands excellence.)
Your muscle capacity [or ability to do work, as measured by strength, endurance, flexibility, and stamina] can make a PAINFUL BACK WITH STRUCTURAL DAMAGE symptom-less.
For fitness help, find a Crossfit affiliate or reputable personalt trainer to help you. (Please note: In my experience, not all Crossfit Coaches are created equal, just as it is with lawyers, doctors, and accountants. Crossfit can cause serious damage if done improperly. I’ve personally witnessed a handful of my patients cause permanent damage and therefore need surgery, by sloppy form with unexcusable coaching. Seek out the best).
Inflammatory foods decrease the symptom threshold for musculoskeletal pain. Put simply, diet is the #1 premature killer of Homo sapiens and their dogs, who are fed weird brown pebbles (aka “dog food”) or the humans’ left-over pasta.
If the pasta isn’t good for you, what makes you think it’s good for the dog?
For dietary/nutritional help, check out my gurus:
- Diane at Balanced Bites – general education of Paleo foods
- Dr. Alex Rinehart – specific education of actual nutrients, complete with blood testing
Take Home Message
- An MRI is a helpful piece of information. But it means nothing without the other details.
- 80% of chronic pain is caused by a) weakness and b) bubble gum. Cover your bases.
- An inflammatory (non-Paleo) diet is MUCH more dangerous than a herniated disc. Back pain stinks, but dying stinks worse.
There. A nice, healthy dose of perspective. : )
Dr. Christopher Stepien is a chiropractor, chronic pain specialist, and A.R.T. provider, and clinic director of the Barefoot Rehabilitation Clinic in Northern NJ. He has been trained under the Integrative Diagnosis system for “clinical excellence”. He loves to help people in ANY way he can. Please reach out to him if he can be of a service in any way. It doesnt hurt to ask.