08 Oct I Don’t Care About Your Herniated Disc
Here’s what I have to say.
I don’t care about your herniated disc. Or your torn labrum. Or the arthritis in your neck. ~Yours Truly
Please don’t take this to mean that I don’t care about you or the suffering you’re experiencing right now.
It’s just that I don’t care what your or my own fancy pictures (x-ray, MRI, crayon or whiteboard drawings) look like or what you’ve been diagnosed with by someone else (assuming that it’s an incomplete diagnosis).
Our patient Natalie was even scheduled for microdiscectomy for her horrible disc before deciding to get checked for adhesion first. Thank goodness she did because she was able to cancel her surgery!
All of this “not caring” talk is somewhat facetious. The fact that the structure of your body is not ideal does tell me something about your body. However, it’s one piece of the puzzle.
The Research on Herniated Discs
In a 1994 study by the New England Journal of Medicine, researchers sent images of 98 “healthy” (no symptoms) backs to two neuroradiologists, asking for a diagnosis.
Only 20% of the SYMPTOM-LESS individuals had clean MRIs. That means no herniations, sequestrations, extrusions, dragons, or monsters present.
52% had a bulge at least one level.
27% had an extrustion.
1% had an extrusion.
Conclusion: 80% of healthy and symptom-less individuals had MRIs that a doctor diagnosed as a problem.
Second Conclusion: Approximately 85% of low back pain cases have no definitive diagnosis.
Let me summarize the research: I don’t care about your “herniated disc.”
What Does An MRI Do?
In a report done by the Radiology Society of North America in 2007, imaging has two roles.
- provide accurate morphological information (what the “structure” of the spine looks like and identify structural dysfunctions).
- influence therapeutic decision making.
No one denies that imaging such as MRIs successfully accomplish #1.
The problem is with #2.
Any study looking at the natural history of degenerative disk disease, prognostic value of imaging, or its effect on therapeutic decision making will be confounded by the high prevalence of morphologic change in the asymptomatic population.”
[the boldness is mine.]
The MRI is very successful at taking a picture of the joints of the body.
Again, this is only one piece of the puzzle.
As a small piece, I normally refer out for an MRI in these situations:
- when five treatments have not produced permanent, sustainable reduction in symptoms.
- serious trauma to the low back.
- lower extremity numbness/tingling that is not provoked by musculoskeletal movements.
- lower extremity numbness/tingling/weakness that has lasted more than a month.
- serious “saucerization” of the low back (more on this in another blog post. “Saucerization” is a fancy way of saying that the lumbar spine has been damaged and the muscles at specific levels won’t relax and stretch, either due to spasm or adhesion.)
In the above cases, an MRI can help let the doctor know if treatment should begin/continue or if surgery is the right solution.
Is Conventional Wisdom Correct?
This equation is merely a moment in time and is missing depth and specificity to the puzzle.
At this moment in time, you’re in pain with a certain amount of structural change to your body (as evidenced by the MRI). The “answer” part to the equation is trying to protect you based on what conventional wisdom knows. Doing specific movements will only increase the amount of pain and damage done to the structure of your body.
Conventional Wisdom has served us human beings in the past by showing us that there were pieces of the puzzle that we didn’t know existed.
But CW is still missing pieces.
What I Care About
I often wonder at the above advice “How are you supposed to use the toilet bowl when the doctor says you’re not allowed to squat?”
That advice makes me realize, every healthcare practitioner is doing the best that they can.
The most holistic of practitioners are letting you know all of the pieces to your pain and health puzzle. He then let’s you know the best tools for putting those pieces of the puzzle together.
What I do I care about is completely and holistically identifying all dysfunctions, relevant pathologies, and pieces of your pain puzzle, which may include:
- other structural dysufunctions (ie. osteoarthritis, morphology issues of your hips like CAM or pincer malformations)
- the amount of adhesion (aka fuzz, bubble gum, scar tissue, or glue) in your soft tissue between your muscles, ligaments, nerves, and tendons as evidenced by flexibility tests like the:
- a lack of strength, endurance, and stamina of your muscles, especially in your Lunge.
- the level of system inflammation you have in your body from consuming inflammatory foods such as grains, dairy, sugar, processed foods, and artificial sweeteners (we recommend Chris Kresser’s paleo elimination diet).
- how much emotional stress you’re under, possibly leading to adrenal fatigue.
- how many hours of sleep you get.
A graph of your dysfunctions and with sweet-spot solutions for those dysfunctions may look like this:
Take Home Message – Eat Your Humble Pie
Humble pie satiates you. It tastes good when you digest the truth of your condition and state of life.
Spoonful by spoonful, here is what you can start to metabolize from above:
- An MRI is a helpful piece of information. But it means nothing without the other puzzle pieces.
- The most common cause of chronic pain that no one is talking about is the dysfunction adhesion.
- Weakness and systemic inflammation are far scarier than your herniated disc.
More on that later.
There. A nice, healthy dose of perspective. : )