11 Oct MRI Scans for non-specific lower back pain – can they lead us down the wrong treatment path?
It is not uncommon in a clinical setting to have patients consult us with nonspecific lower back pain. This is the type of pain that may or may not have had a trigger and may or may not have consistently reproducible aggravating factors. The type of pain is often a mild, moderate or severe ache and often doesn’t radiate down the legs. Functionally, this pain can often reduce a persons ability to do their normal daily activities and their workplace activities. One thing we are often questioned about as health professionals is whether the patient needs to undergo scans of their back to identify the cause of the pain.
Chris made a great infographic on the results of a great study and uploaded it onto the Enhance Physiotherapy facebook page last week. This study was undertaken where a cohort of elite level adolescent tennis players, playing at a national level of completion and who had never had any signs or symptoms of back injury, underwent an MRI of their lumbar spines. This study included 33 tennis players with a mean age of 17.3 years old (range 16 – 23 years old), 18 male and 15 females. The images were reviewed by two musculoskeletal radiologists and the results were as follows:
– ONLY 5 / 33 players had an MRI considered normal.
– 23 / 33 players demonstrated facet joint arthropathy (osteoarthritis)- most commonly at L5/S1.
– 10 / 33 players had a synovial cyst formation.
– 13 / 33 players had disc degeneration with one player having disc degeneration of 3 levels (15 discs in total). Mostly at L5/S1.
– Of the 13 players with disc degeneration, all had disc herniation with 12/15 (discs) being broad central and 3/15 focal central disc herniations. One was considered moderate and together with a constitutionally narrow canal, resulted in moderate spinal canal stenosis.
– 9 / 33 players had pars defects, all affecting L5 level with one having an additional L4 defect (10 Pars injuries in total).
– 6/10 were bilateral, 3/10 were right unilateral and 1/10 was left unilateral.
– 5/10 were chronic stress reactions, 3/10 were chronic stress fractures and 2/10 were chronic subtotal stress fractures.
– Of the 3 chronic stress fractures, 2 had a grade 1 slip (mild to mod narrowing of exit foramina) and 1 had a grade 2 slip (moderate to severe exit foramen narrowing).
These results go to show that it is possible for people with absolutely no history of back pain, and are very active with sports and functional activities, to have what would be considered significant injuries. Had they suffered an injury and then undergone a scan, it would be quite feasible to think that they may have ventured down the incorrect path of corrective surgery on something that was potentially not the cause of their pain in the first place.
The best approach, which is supported by countless studies to date, is to remain active and to have a specific exercise program and reintroduction to manual tasks. This can be done at Enhance Physiotherapy by any of our wonderful physiotherapist, so if you are struggling with lower back pain, book yourself in and we can help you get on the road to recovery.