The Disc Jockey of the Lower Spine.
Disc prolapse.. bulge.... herniation... protrusion.. remmmixxx.
Who here feels that the DJ is playing around with the disc in their lower back all too frequently? Or has heard that their discs are just degenerating all together?
Have you suffered or currently suffering from lower back pain with symptoms radiating into your leg? Or have you been diagnosed with something that contains disc in the name (ex. disc bulge, degenerative disc disease, disc prolapse or my favorite, a slipped disc?)
If you answered yes, you are definitely not alone.
Low back pain and symptoms of sciatica are very common in developed countries. I would say that low back pain is probably the most frequent condition that I see in clinic but just because it is common, doesn't have to mean it is normal and definitely does not mean it is insignificant.
The goal of this post it to simply share with you one, actually two main messages.
#1: If you have pain in your lower back and/or discomfort going into your leg and waiting for it to get better on it's own, you may want to consider getting help sooner than later.
There is evidence to support that people who address their lower back and/ nerve pain early on are at lower risk of developing chronic pain. The truth is, your symptoms may very well get better on their own; you may have had a similar episode previously in your life and have tricks to manage them independently and that's fantastic. However, if you don't know what to do and just hoping it will go away, things could get worse before they get better. Worsening, ongoing pain can quickly create a snowball effect on your life without you really being aware of it. Living with unmanaged pain can lead to sleeplessness, hopelessness, depression and anxiety, diminished quality of life, and isolation. For some Canadians, unmanaged pain has led to poverty, homelessness, and even suicide (Canadian Pain Task Force Report: June 2019). If we can prevent the snowball, please lets do it! Physiotherapy is a great place to start. A lot of what I do is patient education. I believe the more you understand, the more you can feel in control and the more you can self-manage. Once you understand, there are specific exercises and stretches that can be done to help alleviate your symptoms. Once symptoms are decreased or manageable, progressive strengthening and endurance training can begin. I just want you to know that there is so much you can do, its just about finding what works for you, being patient and allowing time for your body to adapt and progress.
#2: Less than 2% of people with low back pain have potentially serious spine conditions that will require surgery or medical intervention (Low Back Pain- The College of Family Physicians of Canada). Unless there are findings in your history or physical exam that suggest a potential serious or urgent cause (ie Red Flags) for your low back pain, then getting a MRI or x-ray is actually discouraged. I won't list the red flags, but if someone reports their legs giving out, or progressive weakness in one or both legs, this sort of thing makes my ears perk up. This is something I would want to investigate further and depending on the rest of the presentation, I would probably send a letter to the doctor. Remember, this is rare.
Many people think that getting an MRI will solve their problems and they will finally know exactly what's causing their pain. I can totally understand why people would think this way, however, most often than not, once receiving the MRI results, nothing changes. Sometimes having piece of mind that nothing dangerous is happening in your spine can help, but unfortunately most of the time the MRI results showing "degenerative disc disease" or something like "disc protrusion" do exactly the opposite. The results are "perceived as dangerous" and actually do more harm than good. The reality is that these are normal aging processes of the spine, but the fear associated with this sort of language makes things worse for the patient. Sometimes the findings are directly correlated to the pain, but sometimes they are not. If the findings are directly related to the symptoms, and in the carefully selected patient, there could be benefits in steroid injections. Please remember that these sort of medical interventions should be viewed as enablers to movement. If the medical intervention is targeted at providing temporary relief so that you can start moving slowly, and getting back to the things you love to do in life, then great. If these interventions are given on their own as the "cure" than not so great.
Take home messages: lets prevent chronicity of your back pain and/ sciatica by taking action today and try NOT to rely on medical imaging to solve your symptoms (unless you present with red flags).
Please reach out if you have questions or would like guidance. I would love to help.