An MRI shows that you have a disc bulge in your lumbar spine…there’s the explanation for your back pain. The diagnostic imaging techniques available today allow doctors to confirm or rule out various conditions and formulate an appropriate treatment plan. Although these tests are extremely helpful and can be lifesaving, it’s sometimes very easy to simply attribute back pain to a disc bulge. What if the true cause of pain is different and you’ve had that disc bulge for many years?
A study published in this month’s British Journal of Sports Medicine1 examined lumbar spine MRIs of 33 elite, asymptomatic tennis players. They found that 84% had lumbar spine abnormalities including disc herniation, degeneration, and joint/bone injuries, without any pain. I’ve worked with patients with back pain diagnosed by MRI with a disc bulge, but their clinical findings are more consistent with sacroiliac instability or abnormal joint mobility in certain regions of the spine. In some cases, treating them for a disc injury actually made them worse, but treating the true cause of their pain resulted in significant improvement.

I think it’s important for patients to understand that their MRI findings, however real and accurate, may actually have nothing to do with their pain. As a result, if your diagnosis is disc herniation and traditional McKenzie exercises (typical group of exercises designed to encourage the disc to move back into place) are prescribed but you don’t get better, maybe you need to talk to your doctor or physical therapist about potential alignment problems, instability, or strength and flexibility imbalances that may be causing your symptoms. A different treatment approach or working with a different provider, such as a chiropractor, massage therapist, acupuncturist, or Rolfer may be what your body needs to heal.

1 Alyas, et. al. “MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players.”

Br J Sports Med. 2007 Nov;41(11):836-41.