I Don’t Care About Your Herniated Disc

by Dr. Christopher on May 1, 2012

Oh no! It’s the end of the world! Or is it?

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.

  1. provide accurate morphological information (what the structure of the spine looks like)
  2. 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:

Take Home Message

  1. An MRI is a helpful piece of information.  But it means nothing without the other details.
  2. 80% of chronic pain is caused by a) weakness and b) bubble gum.  Cover your bases.
  3. 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.

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{ 9 comments… read them below or add one }

Anne Marie August 19, 2012 at 6:56 pm

Having such a hard time giving up grains and dairy!! Someone help me!! When I see them described as “inflammatory” I know I should try to give them up for a while and see what happens… but I’ve been weak!!! I am going to try harder. My knee hurts and I already have arthritis in my finger which is very painful. OK, today is the day I will try harder!

Dr. Christopher August 19, 2012 at 9:01 pm

I like your wording AM. That you’ve “been weak.” Because you are inherently not weak, just having weak moments. We will discuss.

Katrina November 26, 2013 at 4:03 pm

I just tripped across your site while searching the internet looking for answers…I believe I may have a herniated disc. All of the “treatment” options I’m reading up on just talk about pain management – pills and injections, which I don’t want. I just want to heal so I can work out again. I crossfit 4-5 times a week and I have no idea when I can start back up, or what movements are safe. I’ve been warned against chiropractors, but your post is the most reasonable thing I’ve seen yet. Wish I lived in NJ!

Dr. Christopher November 27, 2013 at 1:20 pm

Hi Katrina,

I’m glad you commented. Well, let me know how I can help you. For now, where do you live? Go to activerelease.com and type in your zip code in the “Find a Provider” section. See who is near you.

In the meantime, know that 4-5x/week of conventional crossfit is a lot of LOAD, but doable, especially if you’re a high-end athlete. But to offer you a different perspective, I’m a former college football player, currently playing rugby, and I can hardly do more than 2 days of crossfit/week. Something always gives out. In other words, you may just be doing too much, especially if the coaches aren’t individualizing WODS just for you.

Let me know your thoughts and I’ll help any way I can.

Chris

Kirstin June 2, 2014 at 8:04 pm

So glad I’m on the right track. I already eat a paleo diet (though I’m going to get much stricter about it), but due to my autoimmune disease exercise has been problematic since most causes stress on the body. I’ve been intrigued by Crossfit because I do need to get stronger, plain and simple. How can I, someone who is pretty much clueless, know if a Crossfit trainer is good or not (like you mentioned in your post)? They all sound like they know what they are talking about. What clues do I need to watch for?

Dr. Christopher June 3, 2014 at 3:01 pm

Hi Kirstin, look up Chris Kresser’s autoimmune protocol for people eating Paleo. It helps even further than the strict Paleo Diet. As far as good CrossFit coaches, do they do functional testing before starting On-Ramp or Orientation? Do they modify workouts for those with injuries or at different skill levels? Do they push everyone every single workout to be lying on the ground in a sweat angel (OK once a week, anything more than that is too much)? These are the questions I would ask.

Continue to reach out if I can help.

Victor September 2, 2014 at 4:49 pm

Hi Dr Christopher;

I practice weightlifting 1.5 year ago, two months ago i started a very intense routine with high loads and high reps with heavy weights (hypertrophy added to my olympic routine). On july 30th I had a hard workout day, one workout included 4 series of 10 reps squats with heavy weights (80% of maximum squat), unfortunately I did not use a weightlifting belt, so the next day I felt a pain in the back of my right leg for some minutes, the pain dissapeared by itself. On august 1st, during my warmup session i realized i couldnt reach my right toe with my right hand with extended leg because i had a terrible pain behind my knee when i tried this action, i continued training because i was able to do any exercise. Since this issue was not confortable i decided to visit to chiropractor (who did massages, electricity, heat, in my leg) on august 2nd, i think it was a bad decision since after chiro session i was worse. On august 6th i visited again to chiropractor and i finished worse, the pain was continuous and more notorious when i walking (pain located in external calf). On august 7th i visited to the doctor and diagnosed a sciatic and also sent me to physiotherapy, my condition did not change (i stopped my training). On august 10th i visited to traumatologist who ordered a MRI, also gave a NSAID treatment. On august 17th after reading mi MRI, the traumatologist indicated me that I have a extruded herniatic disc in L4-L5 jeopardizing the sciatic nerve vía L5 and passed me with a neurosurgeon. On august 18th the Neurosurgeon after check my MRI (He said 60% of disc is extruded), requested me a electromyography immediately. On august 20th the neurosurgeon verifified the electromyography and he said there is a little problem with my sciactic nerve, so if he have to make a decision based only on the MRI, the decision would be to perform a surgery. However since I do not show problems with my movements, he has decided to wait for 15 days and also prescribed me a treatmen with celecoxib and tensodox (Ciclobenzaprina Clorhidrato 5 mg). Currently the pain has gone (I stopped training for 4 weeks aprox.) , although a very little pain appears sometimes sincecerly i am not sure about this litle pain, i do my normal life but without training. However I am not sure if i can continue with my regular training. Now I am able to reach my toes with my hands, however I’m very afraid. Thanks for your patience.

Marta Olovets February 24, 2015 at 12:08 pm

Current medical student, a health and moderate exrecise advicate, reasantly felt hip pain coming from low back. Trying to ignore and continue going to exrecise classes (I have weak muscles in the back and been trying to build them up), finally decided to do NSAID’s (declofinac, I refused steroid meds injections for ten days, plus self prescribved Bcomplex shots thinking that I pulled muscle or overworked my hip in the gym. Pain haven’t alleviated, but has become continues. Neurologist suspecting slipped disk and next step is MRI.I am not in horrible pain, its bearable, but its bothersome made me stop exrecising for a month.Any recommendations you could give me. I really don’t want to go Western medicine way, and will prevent surgery at all cost!!! Thank you for your time,
-Marta O.

Dr. Christopher April 28, 2015 at 6:51 am

Hi Marta,

I think it’s safe to say you are far from surgery at this point. How does it feel currently? Can you touch your toes? When does the pain intensify? With a specific movement or time of day? Let me know the answers to these questions and let’s discuss.

Chris

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