low back pain

MRI scans for low back pain

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MRI scans for low back pain – when are they useful.

Lower back pain is common with almost all of us suffering from it at some stage in our life. Most times it settles fairly quickly and other times it responds to treatment. Scans or investigations usually in the form of MRI or CT are recommended when it doesn’t settle in an acceptable timeframe or your physio and doctor indicate it is recommended earlier.

low back pain scans and diagnosis newcastle physiotherapy

The purpose of this blog is to reduce fear or concern if you have scans that show pathology. Although any pathology seen on imaging can be responsible for your pain, it doesn’t have to cause pain. The following table is from a systematic review in the American Journal of Neuroradiology. It looks at lots of research studies where they have scanned the lower back in people who don’t have any pain. The table below shows the % of people that when they had scans they found pathology BUT these people did not have any symptoms or low back pain. In other words pathology is a common finding in people who do not have lower back pain.

20yrs 30yrs 40yrs 50yrs 60yrs
Disc Degeneration 37% 52% 68% 80% 88%
Disc Bulge 30% 40% 50% 60% 69%
Disc Protrusion 29% 31% 33% 36% 38%
Disc Annular Fissure 19% 20% 22% 23% 25%
Facet joint Degeneration 4% 9% 18% 32% 50%
Brinjikji et al, 2015. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol 36:811–16 Apr

The highlights in the table show that 37% of those in their 20’s had some disc degeneration but no pain. In the 30s age group it had increased to 52% but again no pain. If a scan is likely to show normal pathology associated with age but doesn’t mean you will have pain and it’s also not going to change the treatment, then scans are not recommended. So if you do have lower back pain, scans are not usually recommended in the early stage.

If you have low back pain, firstly you should manage the pain with simple analgesics such as paracetamol; stay active as tolerated and occasionally use positions that offer short term relief. In acute low back pain, physio can help with the posture and movement means to reduce pain.

There are times when you do need to have scans straight away and your doctor or physio will identify those occasions. For example if your pain is severe, worsening or if you experience neurological symptoms such as weakness, tingling or numbness, then you need to be assessed by your physio or doctor.

If you have back pain and it is affecting your ability to be active then contact us for an appointment. We believe in an active approach to treating low back pain. Contact us on 4921 6879.

Low back pain … learning to take control yourself

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Low back pain

A recent journal article in the Medical Journal of Australia* prompted this blog to encourage our clients to learn more about how they can take control of back pain. Low back pain gets 80% of us over our lifetime. It often resolves without treatment in the first week or two but recurs in up to 70% of cases. It is also common in adolescence (up to 50%). The assessment of back pain must consider the mechanics or movement relative to the muscles and spine itself however red flags and biopsychosocial factors are equally if not more important.

Red flags are indicators of medical conditions (rather than musculoskeletal cause of back pain) that need to be considered via assessment and sometimes GP referral. The diagnosis process sometimes involves investigations via Xray or MR scans which is important but comes with risks of opening a pandoras box of what may be causing the pain (e.g. knowing there may be a problem with our spine often adds to the psychological side of how pain can persist, when in fact we shouldn’t be worrying about most of the findings on scans). It is generally understood that in a small % of cases (usually <20%) a problem identified on investigations can be related to the cause of a person’s pain. In the rest of people with back pain the findings do not correlate with what is causing their pain.

For the 80% which is the majority, the word biopsychosocial is now generally applied to understanding the reason for a person’s back pain. Yes we still need to rule out the red flag problems and the persistent mechanical back pain coming from the musculoskeletal system. But the 80% of people with low back pain need to consider the many contributors that are often psychological, social and environmental / lifestyle factors. These must be considered in taking control of back pain. Getting a good opinion early on that considers all of these factors is essential but sadly is not common enough.

Good things to remember with low back pain:

  • Getting active helps a lot of people take control of pain. The reason why can be complex but it works … you just have to find the exercise that suits you best.
  • Stress is a big factor with persistent pain. Just considering this is a start towards managing the problem.
  • Surgery is rarely the answer for low back pain.

* Atkinson & Zacest MJA 204 (8), p 299-300, 2 May 2016

Low back pain – Is it in the way you move?

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woman doing fitnessMedical literature places all those with low back pain that have no pain down the legs or other nerve or medical features into one group “non-specific low back pain”. It is a large group (approx 80%) of all people who have low back pain. So how do we best help such a large group of different people with non-specific low back pain? Every person is different in their physical makeup and past experiences.  We cannot separate the ‘who’ you are from the ‘what’ is wrong when answering this question.

 5 areas worth considering when helping someone with non-specific low back pain.

1. How much sitting do you do? As a nation, we are now sitting more than ever before thanks mostly to computers. Remember the message from Dr Mike Evans and his 23 1/2 hrs video! If you haven’t watched it, click here to learn what’s the single best thing we can do for our health.

2. How much movement/exercise do you do? Too much of any position can make us sore, and simply doing something different can offset that. Walking to counteract the sitting can help those who have pain with sitting. If that is you, start a regular walking program.

3. The way you move can predispose you to pain. Dr Peter O’Sullivan is a world leader in researching back pain and remains a practicing physiotherapist in WA. His research looks into sub-classifying mechanical low back pain into which movements increase it and improving how you move to reduce it.

4. Core strength – this actually has the least amount of research behind its benefits. Sometimes strengthening the back and abdominal muscles does work (as evidenced by those doing pilates) but other times it creates pain.

5. Stress levels – this is a common contributor to low back pain. Occasionally it is the main cause of the pain but often being stressed just makes your pain worse. There are lots of resources to help in this area but starting with your GP is a good option.

Management needs to identify and address all of these factors. Get moving if you aren’t already (if the pain allows you). Get out of the chair as much as you can. Look at what movements or postures make the pain worse – that’s where your physio can help the most! Consider your stress levels relative to the pain. Lastly you can start core exercise/pilates if there is no increase in pain – note there are many types of core exercises and choosing the right level and having the correct technique is important. Sometimes it helps because it’s just another method of getting you out of the chair and active.

It’s a lot to consider but if you have back pain that is affecting your life then you need a physiotherapy assessment. We will get you moving in the right way. Let us know if we can help at 4921 6879 or email admin@numovesphysiotherapy.com.au.