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You Can’t See Pain On A Scan

Midland Physiotherapy Lateral Hip Pain

As health practitioners, we are always trying to work out the best way to care for our patients. That’s our role after all. That’s why it is important to keep up to date, and from time to time, we find out new things that dramatically change what we recommend to our patients.

Cast your mind back to many decades ago – smoking was considered safe, patients were given drugs that are now known to be harmful, and we even used to tell people with back pain to just lie in bed to make it better. I know it all sounds crazy now, but at the time it seemed like the right thing to do.

So, you are probably wondering “what is the new thing now?”

You can probably guess from the title. You can’t see pain from a scan. 

For many years I have been saying that “I treat people, not scans”

However, for many patients and health practitioners, there currently exists a strong misconception. We have thought that pain can be explained by things like, disc bulges, facet joint arthritis, cartilage changes in knees and hips and labral tears in shoulders on scans. What is interesting is that there isn’t much correlation between these findings and the level of pain that a person is experiencing.

For example, health care practitioners have told back pain sufferers for many years and some still do, that disc bulges seen on a scan are the cause of their ongoing back pain. The overwhelming scientific evidence now suggests that disc bulges usually exist before a patient has back pain and aren’t closely linked to ongoing pain or disability.

Midland Physiotherapy Lateral Hip Pain

I know that this sounds counter-intuitive, but it is well known now that a large percentage of pain free people walking around today have numerous disc bulges. It’s also common to see no changes on a scan in someone with severe low back pain. We now know that disc bulges are little more than a sign of aging and are much more common in the elderly. Almost like a wrinkle on the skin. As you get older you see more of them. The good news is they are certainly not linked to pain or disability levels. To emphasise this point, an interesting fact that we now know is that back pain typically is less of a problem in an elderly than in a middle-aged spine.

Don’t get me wrong, yes, you might have back pain and yes, you might have a disc bulge on your scan. However, there are a lot more factors at play than simply having a disc bulge, especially if your pain has persisted for greater than three months. In most cases people have these scan findings before they get pain and before they go and see the Physio or GP for an MRI.

Yes, a very small percentage of disc bulges can be linked to back pain. These are usually the severe, traumatic bulges that at times need surgery. These are rare and symptoms include numbness and weakness in the leg and also at times bowel and bladder issues.

So, what does this mean to a person suffering from low back pain? Well, the most helpful thing to know is that if you have some changes noted on a scan, it doesn’t mean that you are going to have long term problems. Remember what we said about how common disc bulges are in the general pain-free population? In these cases, these structures have healed up and stop causing pain. Regular movement and normal activity hugely help this to occur.

The great news is that this new knowledge gives back pain sufferers who have been told their pain is due to a disc bulge, avenues for improvement. When people understand that their pain is not related to any damage they see on an x-ray or MRI, it can lead to improvement in both pain and disability and result in people getting back to the things they enjoy most.

This is because back pain that persists can be more related to other issues in someone’s life like the amount of physical activity they are getting, levels of confidence in their body, the way people are moving, high stress levels, anxiety or depression, and many other factors.

A common example of this is the person who injures their low back lifting something heavy. It is common for this person to get a scan done which may show disc bulges and other degenerative changes. 

As you can imagine, this all sounds very scary for a lot of people, and when you are in pain, it is very common for that person to become fearful and guarded in the way that they are moving, reduce their general physical activity, become stressed and sleep poorly -all contributing factors that are not helpful when it comes to recovering from injury.

What we now know is that these changes are frequently normal in pain free people and most likely existed before pain was present in the back and before the lifting incident. So, what does this mean for you, especially if you have been suffering from pain for some time?

You need to connect with a health practitioner who is aware of these factors and can help you to the best solution. My colleagues and I have the tools to help you makes sense of your pain problem and move you in the right direction. The truth is, you likely have a great avenue for change and that’s exciting! Call today to discuss 9274 1482

Midland Physiotherapist Susan Kingston

Nic Saraceni

Undergoing PhD in Chronic Low Back Pain

Nic has a strong sporting background mainly in golf, soccer and triathlon. He is currently in the process of publishing his research on the role of hip rotation in golfers with lower back pain. Nic is also an avid cyclist and offers a specialised bike fitting service to prevent or overcome cycling related injuries.
Nic has a strong passion for Physiotherapy, along with undergoing his PhD in low back pain, he also teaches Physiotherapy at Curtin and is passionate about producing more capable Physiotherapists and developing the profession.

Special Interests:

  • Whiplash
  • Headache
  • Persistent Spinal Pain

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