Let’s start with a story. There was this patient. He was young, reckless, and non-conventionally handsome if you really have to know. He came in with excruciating low back pain. This poor boy-next-door-type had a work injury from awkwardly lifting a box full of bananas. The pain came on right away and it was severe to the point where there was no way he could do anything but lie down and writhe in agony. The young Tom Cruise doppelgänger struggled his way home with a constant pain that kept on shooting into his left hip and leg. He was frightened, scared, and alone... until his mom picked him up.
In addition to the pain, he had two burning questions:
1) What the bloody hell happened to my back?
2) Am I going to recover from this?
Soon after these events, the poor handsome soul went to get some medical imaging. He didn’t want to wait the requisite 8 months, so he opted to go through the private channels and pay out of pocket for an MRI.
One thousand dollars later, the results did little to reassure:
-“L5-S1 full thickness posterior disc herniation”
-“foraminal narrowing with L5 nerve root impingement”
-“disc and joint degeneration at all levels”
The hero of our story almost had a heart attack from all this; but instead of giving up, he set his jaw and decided that grim determination was the way to go. He was going to get better, no matter what.
First things first, he had to figure out what all this stuff meant. He was recommended to go see a Physiotherapist and found a wizened old physio lady who laid it all out on the table. She told him a few key illuminations:
1) "This type of presentation [severe and acute low back pain] is actually really common."
2) "In almost every single case, folks with these symptoms get 100% better without any sort of surgery or injections."
3) "Almost everyone who gets an MRI will have scary imaging findings. Take 100 healthy, pain free adults, and over 60 of them will have the same sort of findings as you have".
At these revelations, our heroin fell quiet. He felt great about the first two points. His determination softened as hope and optimism replaced raw grit. But the third point struck him as being completely un-credible. How is it that pain free healthy people can have full thickness tears, and nerve root impingement?
In addition to being good looking he was polite, and so didn’t question his wise Physio about her assertions. He let his question sit, and did as he was told: continued with his activities, did a few key exercises, and pain relieving movements, and received some hands on therapy. Sure enough, his back pain started to dissipate. It wasn’t quite so constant, it didn’t go into his leg so much, and he was able to do more of his usual life activities. He started to get a bit more pep in his step.
He continued to live his normal life, started working again, and he even started up on some light recreational activities. He suffered a few set backs during this stage and these tripped up his optimism. His hopefulness was many times replaced with doubt, but each and every set back resolved and slowly yet steadily he was getting better. He occasionally sat back and took stock of the situation. He one day surprised himself with the realization that he was back playing soccer, back hiking in the woods, and he had just finished a weekend snowboarding, all without a trace of pain.
One of the side effects this experience had on our bright eyed inamorato was that it sparked his interest in rehabilitation. Between the recovery and the wizened old physio lady, he felt a calling to study the human body. And so he did, and so he went to Kinesiology school and then to physio school too.
He had the opportunity to dig into this whole business about disc degeneration, tears, and impingements as being benign and normal in a healthy population. He searched the research and found countless studies demonstrating the very thing that the wise old physio lady told him.
He learned that tears, impingements, and degenration were tantamount to grey hair and wrinkles, except on the inside. True, sometimes they can become symptomatic but the link is remarkably weak. The explanations for this were never all that satisfying, a disc tear sounds like it should be more painful than some grey hair. None the less, it’s been demonstrated again and again and again. Imaging findings of pathology are very poorly correlated with low back pain.
So how does the story end? Well the don juan of our story finished PT school and started helping other people get over their LBP. He learned all the tips and tricks and best practices for helping people who were in a similar situation as he himself was.
He also got a job at a damn good clinic in Victoria. It’s called Tall Tree. And the patient wasn’t actually a patient… it was me!
Hope you enjoyed my story, and I hope it gives you low-back-pain-sufferers a bit more hope.
-Pain Free Physiotherapist