I would like to say thank you to everyone who voted for Goodemote Physical Therapy for this year’s Saratoga Today’s “Best of Saratoga” award! My staff and I are grateful for the support we receive each day and will do our best to live up to this honor!
Today, I would like to revisit a topic I have written about in the past, lower back pain.
Let’s start at the beginning, back pain is common. Recent estimates suggest that 80 percent of the United States population will experience back pain at some point in their life. Most of the time lower back pain is “non-specific,” meaning there is no primary cause found. This is likely a surprise to some readers because we often think that if we have an MRI we will have the answer as to what is causing our back pain. However, MOST times no primary cause is found. Fortunately, this does not mean there is no solution, in fact, MOST people recover. Only 2%-10% develop chronic problems!
I really want to emphasize this because it is so important to understand that most people will experience back pain and most people will recover! To ensure recovery, the patient must help. The patient is the one experiencing the problem, which means you have all the answers! The job of a medical practitioner is to ask relevant questions that help to discern what the patient is dealing with and how to guide them to success. We need to know as much as we can so we can rule out certain conditions and focus on others. Even then it can be tricky to figure out, but we can at least reassure our patients when it is not a serious condition. Once we rule out the “OH SH--” conditions we can start encouraging people to be more active and avoid things that we know make us worse.
When visiting your medical practitioner come prepared to describe the following:
1. When did your back pain start?
2. Where did your pain start and
3. How did the back pain start?
4. What is guaranteed to make
5. What is guaranteed to make
These type of questions help the medical practitioner eliminate certain conditions that may be causing the pain. Often times patients assume that having an X-ray or MRI is going to determine the condition, but this is not typically the case. I like to tell my patients that the “clinical presentation” needs to match the radiologic presentation. Your experiences are the most important part of the process...after all, you are experiencing the problem and what you are experiencing helps to eliminate structures that can cause pain.
For example, a “degenerated disc” has specific characteristics that make it easier to identify. Degeneration is an issue that is always there, meaning you don’t have degeneration one day but the next day you do. Degeneration of the discs is a normal part of aging, with up to 80% of 50-year-olds having degeneration.
Signs and symptoms of degeneration, according to my education, typically include stiffness after prolonged activities. For example, stiffness in the mornings and after prolonged sitting. Degeneration does not typically cause lower back pain when you bend forward. When we bend forward the joints of the lumbar spine open up and give space, which means bending won’t bother degeneration. Degeneration is predictable and consistent and when your pain doesn’t match the common signs and symptoms associated with degenerative types of pain, I would put degeneration on the bottom of my list of causes, even though the X-ray shows degeneration.
Let me clarify a bit more. We can tell with radiological tests (X-ray or MRI) if someone has degeneration. What we can’t tell with radiology alone is whether or not this is the source of someone’s back pain. This is why the “clinical presentation” is so important. I was taught that the radiology tests should be used for confirming or ruling out a diagnosis. So, when you go to your medical practitioner it is very helpful if you have been paying attention to your symptoms.
A “bulging disc” is another example of a “normal process of aging.” It is also an example of how important it is to match the clinical presentation with the radiological results.
The following statistics will likely surprise many:
1. 30% of 20-year-olds have bulging discs and NO symptoms
2. 50% of 40-year-olds have bulging discs and NO symptoms
3. 60% of 50-year-olds have bulging discs and NO symptoms
4. 77% of 70-year-olds have bulging discs and NO symptoms
This means that people with NO PAIN have bulging discs. Just because something is found on an MRI does not mean it is the cause of the person’s pain. Remember, most of the time lower back pain is “non-specific,” meaning there is no primary cause found.
It is common for someone with disc pain to be worse in the mornings after prolonged sitting and with transitions (like rising from sit to stand). Disc pain is also often worse with coughing, sneezing and straining. I want to know what the patient is experiencing initially because too often people think that a bulging disc means that’s why they are hurting. I also treat a lot of patients that had MRIs from years ago indicating a disc bulge, but now we know that up to 67% of the time the disc will reabsorb spontaneously. Meaning if you had a bulging disc years ago there is a good chance it is not bulging any more.
Example of Spontaneous Reabsorbtion:
Pictured above is a “Before and After MRI.” The picture on the left is of a large herniated disc. The picture on the right is the same person three months later. Notice that the disc is no longer herniated.
It is so important to focus on the resolution of back pain by focusing on doing things that help alleviate your pain and stop focusing on the “possible” cause of the pain. Remember that we rarely know for sure why you are having back pain but most of the time a solution can be found!
“The most important thing to do when you find yourself in a hole is to stop digging!” -Warren Buffet
At Goodemote PT and at Fysiofit we focus on educating our patients and guiding them to managing pain and improving function. We do this by listening to your unique experience and guide you to a positive outcome!
Thank you again for voting for Goodemote PT and we look forward to serving you for
many years!
We are offering workshops every month on topics like Back Pain Prevention, Osteoporosis, Therapeutic Yoga, Running Workshops, Injury Prevention, Sports Performance and many more. If you are interested in hearing about our upcoming workshops please call 518-306-6894. We have an email list for people interested in hearing about these events; just email me at This email address is being protected from spambots. You need JavaScript enabled to view it. and let me know if you want to be included in our emails.
