One of the most important questions I ask the patients who come to see me with Lower Back Pain (LBP) is: “What do you think is wrong with you?” Many patients will respond with statements like these: “My doctor said I have 3 bulging discs; or, my spine has major damage because the MRI showed a herniated disc; or, my doctor told me I have a lot of arthritis”. I then look at the report of the CAT scan or the MRI, that shows some disc bulging, minor disc herniation that does not pinch on nerves or wear and tear changes in the discs and the small joints of the back called facets. The vast majority of these findings have NO clinical significance whatsoever and are very common as we advance in age. So, I tell the patients that what they have is not really a big deal and the changes in the Xrays are very common as we get older. Some sign with relief as they were scared “their back was falling apart”.
Other patients get quite upset when I challenge what they thought was wrong with their back. For this particular group, I bring a CAT scan report of someone, which reads s as follows: “Severe multilevel degenerative changes with disc desiccation and moderate facet joint osteoarthritis that causes several foraminal stenosis”. Of course, no one understands a word of this medical jargon except that the person to whom this CAT scan belongs “must be in serious trouble”. This is when the surprise comes: “This person with this terrible CAT scan” is ME, and I have no back pain whatsoever except if I am shoveling heavy snow for hours! In other words, what I am trying to teach my patients is that an Xray or a scan means nothing unless there are specific symptoms that go with the radiological findings.
As we get older, the appearance of certain abnormalities in radiological tests has no more significance to the body than the graying of our hair. There is, though, something very strange that has happened in our Western World over the last 50 years, with thousands of people losing work days because of back pain. During the same period of time the human kind has not seen more herniated discs or more severe wear and tear changes than usual. LBP in our developed countries has been transformed “from just being a part of life” to being a “disability or compensable injury” as we view it differently now than we did many years ago. To understand what I say, we only have to look at very poor countries such as Oman, the Ivory Coast and Nepal. In these countries back pain is considered a part of normal life and despite major afflictions such as polio with shorter and weaker legs or other disorders, it is much less debilitating when compared to Western societies.
I am certainly not minimizing back pain, but I am not prepared to consider it either an incurable villain. I know because I suffered from it for 8 whole years, after the delivery of my first son, taking medications over the counter daily. Years of sedentary life and inactivity had taken a toll on me. My wake-up call came when I had a spinal CAT scan and it showed bad wear and tear. I freaked out. One thing I did not want to do is to become “one of my patients” and end up with surgery. I had only one alternative and this was to take my fate (and my spine) in my own hands! This was 19 years ago. My back pain disappeared within a 3 month period once I decided to start exercising. Since then I truly became a “regular” in the local gym and added aerobic dancing and martial arts as my fitness increased. Strong core and abdominal muscles, keeping a proper body weight and been physically active was the key to my recovery. Don’t get me wrong. My back pain appears from time to time but it takes heavy and prolonged physical work in weird positions to wake it up for a couple of hours or an afternoon. No doctors, no medications and no more tests, except a more recent CAT scan (that I read to my patients) which showed that my spine looks worse now than it did 19 years ago! But who cares! As I always say, it is the person that matters, not the test.