Getting MRI results can be terrifying especially on the lower back when terms like “disc herniation” “disc protrusion” and “disc degeneration” are almost guaranteed to be on the report. These terms are scary enough to give anyone a nightmare and a lot of people cut back on exercise and some activities of daily living to “protect” the area. I see it all the time in clinic where a patient might inform me that they avoid certain tasks because of the slipped disc they had years ago or that they cannot run because they are afraid they might “put their back out again”
Its common and very understanding that someone might get fixed on scan results. Disc degeneration definitely sounds as though that disc’s best days are over and its only going to get worse. The thing that must people don’t understand is that degenerative changes are normal. It is a common age related process and some studies show that as many as 48% of healthy adults between the ages of 20-22 had at least one degenerated disc. Pain can be experienced but is more likely to come from inflammation and stiffness rather than the degenerated disc itself.
A 2014 study saw that 70% of young, healthy individuals had disc degeneration but no pain. The same study found that over 30% had a disc protruding on a nerve but were fully functional and pain free. But if someone turns up to physiotherapy with back pain and a scan result showing degeneration at multiple levels and a disc protruding on a nerve there is immediate panic and a bleak outlook on the future. Its hard to change a person’s belief system and for many people, after hearing these words there’s no unhearing them. Scans should first and foremost be avoided unless something sinister is suspected or if there is no improvement through physiotherapy. They can do more harm than good and sometimes a physiotherapists biggest task is to separate someone from their scan results. It can hamper results and have a massive impact on the way a person lives the rest of their life.
Even full disc herniations are not what we once thought. It was believed that the inner nucleus of the disc bursts through the disc wall and pressed on the nerve. What we didn’t understand was that this can go away with time and conservative management. In a 2001 study 19% of people saw a complete disappearance of their herniated disc after 6 months of treatment. 70% of people in the same study saw a good to excellent reduction.
Therefore, it is important for people to know that they are not their MRI result, at least not for long. It takes some work and sufferers must knuckle down to some exercises that help stabilise and strengthen the spine. Yoga and Pilates classes are always a good place to start and physiotherapy treatments like vertebral mobilisations, soft tissue massage and Dry Needling will also speed up recovery time. In the rare cases where pain does not settle, corticosteroid injections can be used to decrease pain and inflammation.