As advanced imaging is getting more affordable and available, it is important to point out a few things about your most recent MRI. In the last several years, more doctors have utilized both X-rays and MRI’s to better help explain away why a patient is having specific symptoms; both in the neck and lower back. Studies have shown, however, that a certain degree of degeneration is normal. When using this technology on an asymptomatic subject, or someone who has no complaints of neck or lower back pain, images show that even 30% patients in their 20’s will show at least 1 disc bulge. When we get past the age of 50, we see a rise in this number to at least 60% and the degree of degeneration starts to rise. Finally, 77% of patients over the age of 70 will show at least 1 disc bulge and signs of degeneration in people with no symptoms what-so-ever.
So what does this mean for you? What came first? The chicken or the egg?
What is a Disc Bulge?
A disc bulge or herniation is actually a sign of degeneration, along with a loss of overall disc height and increased bone growth. But with research showing this occurs even in healthy individuals with no back pain at all, some of this is normal. 37% of 20 year-olds will show signs of degeneration with that number rising to 96% of those over the age of 80. This is important to keep in mind because although advanced imaging is great for catching some of the extreme cases and causes of pain, it is unable to be determined that a patient’s lower back pain can be correlated with the amount of degeneration seen on films.
Disc Bulge Categories
There are 2 categories that we use for patients with a disc bulge: A – the bulge is not related to your back pain (the more common finding), or B – the bulge is contributing to your back pain. There are treatments for both and we see them in our office all the time. If you fall into the first category, you will be evaluated and treated just as any other patient would be with lower back pain. Adjustments, muscle work and take home exercises, usually to strengthen the core and better stabilize the low back, are used. If you fall into the second category, there are a few more things to consider. 63% of all disc bulges actually resorb or get smaller and heal with time. That means that even if you do absolutely nothing, that bulge seen on MRI will shrink if only you give it time.
Don’t think that we can’t help facilitate and speed this process along, however. Most of the time what we see with a disc bulge that is contributing to lower back pain symptoms is actually areas above and below that injury to be fixated or need to be adjusted. When the body is not sharing motion properly through all of the joints, other areas pick up the slack and they begin to move too much. That puts the lower back at high risk for injury. After irritation and irritation, inflammation begins to build up, creating the perfect environment for disc and nerve injury to occur. Other contributing factors may be diet, activity or overall movement level and even something as simple as water intake. A series of take-home exercises have been found to decrease symptoms tremendously, along with adjustments to the areas of the spine that need to be adjusted. Once the initial injury has been addressed and patients are no longer in acute pain, a conservative treatment that includes strengthening the area around the healing tissue is a must in order to prevent re-injury.
In a very recent interview of the NBA Golden State Warriors head coach Steve Kerr, someone with ongoing low back pain who had surgery in 2015, he explained to the world what we at Keith clinic are telling patients every single day. “I can tell you if you’re listening out there, stay away from back surgery,” Kerr said. “Rehab, rehab, rehab. Don’t let anyone get in there.” In the several weeks after, he has had debilitating pain that has kept him from coaching. After his surgery, he went through a similar episode that rehab helped him with. In his interview, he reiterated that he wishes he would have NEVER had the surgery and that he wishes he would have found REHAB prior to surgery!
Treating Disc Bulge
Bottom line here is that not everything seen on X-ray or MRI is a contributing factor to pain. Even if you see degeneration or disc bulges on imaging performed, conservative treatment is still a great first step. Sometimes when things are explained after having these exams done, patients leave with even more questions along with a feeling of impending doom. Not to worry! Give us a call and we can sit down with you to help you better understand what it all means. Do you have a disc bulge and are now wondering if chiropractic can help? We would love to get you scheduled for a complete exam to get a better idea of your biomechanics overall.
Curious where all this research came from? Check out this article with very easy to read charts explaining results:
W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes and J.G. Jarvik. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Patients. American Journal of Neuroradiology April 2015, 36 (4) 811-816