So, what’s causing my back pain? Short answer. I don’t know. Long answer. It’s complicated. Let us start by just throwing out this table, which since it was published by Brinjikji et al. in 2015 has been cited almost 500 times.
What this study did was fascinating. It took healthy adults in multiple age groups who had no history of back pain and took an MRI of their low back. What they found was that people who are asymptomatic, meaning they do not have any back pain, still had a high number of abnormal findings on their MRI. Many people come into physical therapy and when I ask them to describe their back pain, they tell me, “I have degenerative disk disease”, or “I have 3 bulged disks in my back.” Well, if that person is 50 years old then 80% of people who do not have back pain still have degenerative disk disease, and 60% of those people have a disk bulge. So, why aren’t those people having pain? That is a great question.
Now to be fair, Brinjikji et al. did another study that looked at MRI imaging of people with back pain and they found that across the board, the prevalence of imaging findings was higher on every item listed in the table above. So, if you are in back pain, you are more likely to show something on your MRI than people who are not in pain. However, this still does not tell us why some people can have a disk bulge and be fine and other people have terrible back pain with sciatica. Thick textbooks dig into these questions further to look at size, shape, severity, location, and other aspects of these imaging findings. My main takeaway when I ask people to describe their back pain, I am not necessarily looking for the number of disk bulges or degenerative disks you have. I want to know how your back pain affects you! What can’t you do because of your back pain? What would you like to be doing? Does it hurt to stand, sit, or turnover in bed. Although I still look at your MRI reports and take it into consideration, I am mostly interested in the person and not the image.