Why herniated, prolapsed or degenerated disc do not cause chronic lower back pain
Many chronic lower back pain sufferers get X-Ray, CT or MRI scans to try and find the cause of their lower back pain. These will often diagnose one of the following structural conditions in specific spinal segments (ie L5-S1):
- Herniated Disc
- Prolapsed Disc
- Disc Degeneration
These diagnoses describe damage/change in the structure of the spine. They do not however explain how or even if these changes are the cause of the pain you experience in your back. This is important to consider. Just because you can see a problem in your spine does not mean this is the cause of your pain.
Research findings: Disc pathology does not predict lower back pain.
Current research highlights that disc pathologies (listed above) do not accurately predict the presence of lower back pain. In a ground breaking study Jensen (1994) scanned the backs of 98 normal (no back pain) patients. The results were astounding. Of the 98 subjects, only 36 had what would be considered healthy discs. The 50 other subjects had at least a prolapse in 1, if not several discs and 2 had full disc herniations. Yet NONE OF THESE INDIVIDUALS HAVE LOWER BACK PAIN. This study has been replicated several times with similar results.
So what does my disc pathology mean?
That you are not stabilising and supporting specific vertebrae and discs in your spine. Your spine is supported by a complex set of muscular connections usually referred to as your ‘core’. When your core is functioning well it stabilises and ‘holds up’ your spine as you twist, turn and bend. Essentially it prevents your vertebrae, and therefore discs from rubbing against each other and wearing down. A prolapsed or herniated disc means that your core has not been doing its job; your discs have therefore been taking extra pressure and have worn down.
If you’ve had chronic lower back pain chances are your lower back muscles feel tired. That’s because they’ve been trying to protect your disc and vertebrae from this pressure and there fatigued. Pain is your body’s way of putting up the red light, it can feel your discs wearing down its screaming at you to STOP!
So my disc is not pinched?
MRI studies (Rijn, 2006) indicate that the average disc prolapse/herniation does not impinge the nerve. Patients who did present with impinged or ‘pinched nerves’ found in MRI scan showed significant neurological symptoms, including;
– Loss of bowel bladder control
– Abnormal reflexes
If the disc isn’t the issue….. then where to from here?
When it comes to back pain there are no absolute, one size fits all answers. But as a physical therapist who specialises in LBP there are a few constants
- Lower back and upper gluteal muscles are almost always over worked and tired. In fact it’s often these fatigued and tired muscles which are causing your LBP.
- Weak core stabilising muscles in the abdominals and in the pelvis are usually the cause of these muscles overworking
- In 90% of cases LBP patients present with an Anterior Pelvic Tilt
- Functional rehabilitation is the only sure fire way to cure your back pain permanently
There is the right therapist out there to help ‘fix’ you LPB. He/she should explain to you (in simple terms) what they think is wrong with your back; and how they will try and fix it. Its your job to learn as much as possible about your back, so that you can accurately judge whether they are the right fit for you. Please check out the other blog posts (also linked throughout this page) on this website for more information to the causes and answers to LBP and other injuries. Otherwise please call/contact SUPT directly for an individual explanation and assessment of your body.
Rijn JC1, Klemetso N, Reitsma JB, Bossuyt PM, Hulsmans FJ, Peul WC, den Heeten GJ, Stam J, Majoie CB. (2006) Observer variation in the evaluation of lumbar herniated discs and root compression: spiral CT compared with MRI. British Journal of Radiology.
Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain (1994). Maureen C. Jensen, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross, N Engl J Med 331, 69-73