"I have an osteophyte," she said, on the verge of tears.
"The doctor told me I have an osteophyte right in the lumbar spine...I'll probably need injections at least, and maybe even surgery."
This patient had been making excellent progress so far. Her back pain had been progressively diminishing over our past few sessions, and she had been noticing significant gains in her ability to do things like lunge down to the ground to play with her pet and walk outside on the local trail. And then she came in after a follow up physician visit to share with me the news of an uninvited, terrifying osteophyte which was now attacking her body.
But here's the thing. An "osteophyte" is essentially a medical jargon phrase associated with a normal product of aging in many of the joints of the human body. It's a little bit of extra bony growth that, in many cases, is usually even smooth (not as much like a stalagmite as some may think).
And it's completely normal...
This has been a long time coming, but I want you all to know something. I need you all to know something. Something very important...The next time your back hurts, the next time you tweak your shoulder or knee - getting a "deeper look" via the slew of various diagnostic technologies available out there might not be your best choice. You should probably even consider skipping that MRI. I'm serious. If you're looking for your imaging to give you insight on how the next 3 months, 6 months, or longer should look and feel - you're making a mistake.
Your imaging should NOT define your future. And here's why...
Degenerative Disc Disease
I want to primarily tell you about disk degeneration, because it's probably the most common phrase that I hear and read about (with "disc bulges and herniations" coming in at a close 2nd place).
You're probably expecting some biased thoughts about how physios (aside from just sounding way cooler, this is what physical therapists are globally known as) are uniquely qualified to handle a variety of orthopedic conditions.
But, while that's absolutely true, I actually want to specifically share with you the results of a massive systematic review (that's code for "very reliable research that organizes and compiles all the relevant research to date on the topic of _______________"). This study, done by Brinjiikji et al., was published in the American Journal of Neuroradiology in 2015. The profession of Neuroradiology exists to focus precisely on interpreting and diagnosing the human nervous system via tech such as magnetic resonance imaging (MRI) and computerized tomography scans (CT scan). If ever there were an unbiased source to back up this blog post, it's in an article published by these guys.
The authors of this study analyzed the results of over 3000 individuals who had no history of back pain. Meaning, they don't have, nor have they had, back pain. They reviewed the MRI and CT Scan results of these individuals' lower backs and checked them for evidence of a number of pathologies most commonly associated with degenerative changes, such as spondylolisthesis, disc bulges/herniations, etc. The following is an infographic we made that illustrates the findings for disc degeneration alone (the other pathologies also have their own shocking information). Check it out:
Does this not blow your mind?
In individuals age 20-29 WITHOUT BACK PAIN, 37% had disk degeneration;
- age 30-39 WITHOUT BACK PAIN, 52%
- age 40-49 WITHOUT BACK PAIN, 68%.
- age 50-59 WITHOUT BACK PAIN, 80%
- look how it skyrockets from there. And that's just for disk degeneration alone!
Please understand that this is NOT meant to discourage you. I'm not trying to be an Eeyore. I promise!
There's actually an insane amount of HOPE for you to find in this new information:
Your images probably (and by that I mean very, very, very likely) don't have as much to do with your pain as you think. To say that the majority of individuals to your left and right have some form of degenerative spine changes is a perfectly reliable takeaway.
But they don't all have pain. And so how can we explain this inconsistency? If your MRI says the same thing as your neighbor's MRI, why do you have pain and she doesn't?
Because pain is FAR MORE COMPLEX than a picture of your anatomy.
As a physio, I have seen countless patients experience amazing outcomes with conservative treatment and return back to full function- even though they originally brought with them MRI reports riddled with the most terrifying medical jargon imaginable.
It is entirely possible that STRUCTURALLY - what is going on in your back is simply a product of "normal" changes that everyone else is also experiencing.
If you want to really get better, then you need to find a good physio or other healthcare professional that can work with you to find legitimate impairments and help to form a plan of action to address them.
There is so much more I want to share with you about this. This information has the potential to eliminate the fear, anxiety, and avoidance of normal/healthy physical activity that is plaguing your normal routine.
If you have back pain and are struggling, I believe whole-heartedly that your first 2 steps ought to be:
- find a good physio (one you can trust)
- keep moving, my friends.