“My back seemed to be improving” my client said to me.
“I was able to jog again. My bending was getting better…. But…”
“But, what?” I asked, knowing the likely answer.
“My doctor just showed me the results of my scans, and they weren’t good.”
My client sighs and slumps. I sigh silently.
Yet another Victim Of Medical Imagery Technology (V.O.M.I.T).
I’ve been a Physiotherapist for over twenty years now, and have seen thousands upon thousands of these. The research on this (links at the end of this blog) backs up my observation and lived experience over many years.
- There are proportion of people with a number of abnormalities in their bodies (for example research shows that 76% of pain free people have a disc bulge in their spine)
- There are people who suffer persistent pain
- There is no clear link between the above two
Scans like MRI’s / CT scans / US / X-Rays have been a blessing and a curse in western medicine.
The blessings have been the ability to find underlying fractures, tumors, , strokes, haemorrhages, etc. that help a person pin point a particular problem which may help them participate in more effective management.
It’s in the area of back pain / neck pain that these scans have often let us down. Trying to use scans as the main evidence to diagnose a pain problem can be highly misleading.
The process usually works something like this:
- A person has wear and tear in their spine (disc bulge, disc prolapse, osteoarthritis, etc.) increasingly over a ten to fifteen year period – they just don’t know.
- This person develops back pain associated with age or due to lifestyle or workplace factors such as awkward postures, repetitive movements, poor sleep, etc.
- The well meaning doctor sends them for scans and they find out about a score of abnormalities they never knew about.
Now this is where the choices come in. Do you become a VOMIT or not?
Knowledge of hidden imperfections can lead to anxiety about those imperfections… leading to unhealthy beliefs… leading to an increased state of alarm in the nervous system… leading to more pain… leading to being more protective… it can be a vicious cycle.
It’s important to understand that our body has many abnormalities and age related changes that we usually don’t know about. And that’s just fine!
An American Journal of Neuroradiology 2015 review focused on scans of people with no pain symptoms found that a large portion of them had abnormal signs on their scans associated with degeneration. The review concluded:
“Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”
With the thousands of people involved in these studies – the really interesting thing would be how they would feel once they know about these abnormalities. Would they be a VOMIT – or make more positive choices and continue their lives?
What’s more important than your protruding L4/5 discs, or your supraspinatus tear (almost everyone over 40-50 years of age has this to some degree) is:
- How active are you?
- Do you use healthy neutral postures at work?
- Are you strong and flexible?
- Do you have good body awareness and know your limits?
- How is your mental health and relationship with stress?
These are the things that really matter. Focus on these, not your L4/5.
Have a healthy and productive day,
References and further reading
Recent research review: http://www.ajnr.org/content/36/4/811.long
Overcoming Pain (Hall): http://davidhall.net.au/overcoming-pain/
Sensitive Nervous System (Butler): http://www.noigroup.com/en/Product/NSB
Explain Pain (Butler and Moseley): http://www.noigroup.com/en/Store
The Last Well person (Hadler): http://www.mqup.ca/last-well-person–the-products-9780773527959.php
Here is a reference noting that 76% of asymptomatic people have a disc bulge on MRI: https://www.ncbi.nlm.nih.gov/pubmed/8747239