Back Pain—Thoughts on Degenerating Discs, MRIs, and Trying PT First

Let’s take a minute to talk about low back pain—it’s an important topic worth some discussion! Low back pain is the most common cause of disability and lost work time among working-age adults in industrialized countries. Research articles have reported that the world- wide prevalence of low back pain is 11.9% on a given day and a one-month prevalence of 23.2%. That’s a lot of people with back pain! There is also a higher prevalence in women and in people age 40-80 years. Sadly, these numbers regarding prevalence are not improving over time—they are actually gradually getting worse. Therefore, it’s no surprise that patients with low back pain is the largest group of people who seek physical therapy treatment.

When I evaluate a patient with low back pain, it’s amazing how many times I hear these two things:

  1. that an individual’s pain is due to a bad disk and
  2. how an individual needs an MRI to see what is wrong with their back.

Therefore, I think it is worth looking at some interesting facts regarding degenerative disks and MRI utilization.

It has been reported that in the general population, when looking at the entire spine (low back, mid-back, and neck), more than 70% of people under 50 years of age and more than 90% of people older than 50 years of age have degenerative disks. Do you think all of these patients have pain due to their degenerative disks? I sure hope not! Thankfully, the low back pain prevalence is nowhere close to matching these sky-high numbers of degenerative disk frequency. Therefore, my point is that disk degeneration does not equal pain and functional limitations. So, don’t decide that just because you’ve been told that you have disk problems you are going to live in pain forever! For many patients that I see, the root cause of their pain is due to areas of weakness and stiffness that have caused them to move incorrectly with every day activities, triggering their pain development. And this is something that physical therapy is awesome at helping with!

Alright, on to my second point that I wanted to address. MRIs. So many people want to have one done. After discussing how the reported prevalence of degenerative discs does not correlate with the number of patients with pain, I think this is the perfect place to discuss how MRIs frequently have a high number of false positive results. An MRI report might indicate areas of dysfunction; however, over 99% of patients with low back pain do not have a serious condition that truly warrant the utilization of an MRI. Therefore, in the absence of serious signs of worsening neurological function, getting an MRI is more likely just to increase anxiety and lead to false beliefs regarding the severity of your back pain diagnosis. Most of the time, when someone asks me if I think they need an MRI of their back, my answer is going to be no. It’s not worth the couple thousand dollars to be told that you have some dysfunction that is likely insignificant in the development of your pain and is just going to make you stress about having something wrong with you.

One final point that I want to share to let you ponder before I end this blog post. Did you know that early PT treatment for low back pain can actually lower health care costs? It has actually been shown that early PT treatment can lower these health costs by on average 60%. Beginning low back pain treatment with advanced imaging (aka MRIs) increases costs. So #getPTfirst! Those bad discs likely aren’t the cause of your pain and that MRI just costs money! Give physical therapy a try and maybe you’ll be surprised at how great you feel afterwards!