Imaging and Low Back Pain

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You have back pain. You go to the MD. They take an X-ray, even an MRI. They find you have disk degeneration, a mild disc bulge, maybe some facet degeneration. Is this something that is going to cause pain for the rest of your life?

Take a look at the graph. What it shows is that once you reach your 40’s you will likely have some level of normal age related change in your lumbar spine. The good news is most of these abnormalities will NOT cause pain. Don’t be too quick to believe that a disk bulge at L3 is causing your low back pain. Or disk degeneration from L2-L5 is going to stop you from participating in your favorite activities. Your symptoms need to match the imaging for it to be meaningful. If, for example we look at the L3 disk bulge. Significant symptoms related to that would include radiculitis (symptoms along the L3 nerve distribution), burning, sharp pain, weakness and even muscle wasting are indications. If radiculitis is not present then you don’t need to be as worried about that bulge. In many cases of low back pain the cause is mechanical. You cleaned out the garage over the weekend. Monday morning your back is stiff. Tuesday you wake up and are too stiff to stand up straight. These symptoms are likely a result of something you did cleaning out your garage, not disk degeneration, a disc bulge or facet degeneration.

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