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Low back pain myths – Part Four: age, rest and MRIs

This next clip deals with some really important questions that come up regularly when you are helping people with low back pain. The question of ageing and the expectation of low back pain is assumed. The relationship of changes on MRI and back pain is assumed.  We aim to demonstrate that these are simply assumptions and don’t hold true.

If you missed the start of this series with clips of the talk up to this point, click here to go back to the start and see the first one.

If you have any thoughts or comments about this series, feel free to post a comment on our Facebook page at Facebook.com/AdelaideWestPhysio

[If you would like to cut to the chase and get the top 10 myths in a free printable guide, just click here]


Myth #6 – If you have back problems when you are young, they will get worse as you age.

Fact: The incidence of back pain is actually highest between the ages of 35 and 55.

After age 55, people usually have less pain – especially disc-related pain.  That’s not to say that people over 55 don’t get low back pain, of course, but the assumption that things get worse as you get older isn’t true.

If you have had non-specific low back pain when younger, if it is dealt with well and you know the right things to do to manage it independently, you have a great chance of remaining painfree, or at least minimising the impact of future episodes.

 

Myth #7 – Your back is getting old and worn out – ‘you should expect that it should hurt, it’s your age’

Fact: Disc degeneration is a natural part of the ageing process. It is a normal part of ageing for all tissues. That doesn’t mean that it has to be painful!

At least 30% of people who have no low back pain have discs bulging into their spinal canal, and sometimes quite a lot.

Brinjikji et al (2015) reviewed thirty-three articles that looked at the spinal imaging of asymptomatic individuals to determine the relevance of age-specific changes.

This study is worth showing as a table – it shows the rates of different pathologies in people with no low back pain.

For example, in my age group of 40-50 year olds, there are 50% of people that have disc bulges that have no pain! No pain. Think about that for a moment and let it sink in.

Look at your age group and see what the incidence is of MRI changes in people with no pain.

It also shows that even in people free of back pain, the amount of changes on imaging get more and more.  In people with no pain.  Think about that carefully, it is a great piece of information.

 

20yo 30yo 40yo 50yo 60yo 70yo 80yo
disc degeneration

37

52

68

80

88

93

96

disc bulge

30

40

50

60

69

77

84

disc protrusion

29

31

33

36

38

40

43

facet joint degeneration

4

9

18

32

50

69

83

 

Myth #8 – You shouldn’t exercise or work because of back pain.

‘You should rest up in bed and wait for it to heal and be painfree before getting back to work or exercise.’

Fact: Bed rest and missing work are not helpful!!

Short periods of rest, and reduction or modification of load in early days is often necessary but completely avoiding activity until pain has ceases is not recommended and can in fact be harmful.

Early return to work and useful activity shows better outcomes – keep moving!

These decisions about return to work can be made with a well-informed health care professional.

Motion is lotion.

 

Myth #9 – An MRI / CT / Xray will show what is wrong with your back.

Fact: Only specific symptom patterns in a minority of cases indicate the need for an MRI scan or other sophisticated tests.

The treatment guidelines are that MRI and back pain, and other investigations are to be used if the result could change the treatment approach, or if there is legitimate concern about a serious condition or another medical condition.

All physios are educated on screening for ‘red flag’ conditions ie conditions that may be serious.

What that means is that only a minority of low back pain sufferers need to have investigations, so don’t give your GP a hard time and demand an MRI if they think that it isn’t warranted!

In the video, I also talk about the ‘downstream’ effects of imaging – once you know you have a bulge, you can’t ‘unknow’ the you have a bulge, whether it is relevant of not.


If you would like to speak directly with a physio to discuss your problem, simply book online for a free 15 minute pre-assessment consultation, or you can call us on 8356 1000 to organise your free pre-assessment consultation.

This session can be in-person in the clinic, which is recommended as you will get more useful information. It can also be a phone call consultation for your convenience.

 

 

YouTube video

If you missed the start of this series with clips of the talk up to this point, click here to go back to the start and see the first one.

If you have any thoughts or comments about this series, feel free to post a comment on our Facebook page at Facebook.com/AdelaideWestPhysio

[If you would like to cut to the chase and get the top 10 myths in a free printable guide, just click here]

 

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About the author

Russell Mackenzie
Russell Mackenzie
Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
Russell Mackenzie

Russell Mackenzie

Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
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