Despite overwhelming scientific evidence to the contrary, it has been a fairly common practice for health care providers to blame radiographic findings (x-ray, MRI, CT scans) of multilevel degenerative changes in the spine (spinal joint arthritis) as the cause of low back pain.
In a 2008 study published in Spine Journal, no relationship between degenerative changes in the spinal joints and low back pain was found in 3529 participants. According to lead author, Leonard Kalichman, PhD
“In the present study, we failed to find an association between facet joint arthritis (osteoarthritis), identified by CT scan, at any spinal level and low back pain in a community based study population.”
Although the results demonstrated a high incidence of degenerative changes in the spine that increased steadily with age, the relationship to low back pain could not be established.
These findings were consistent with previous studies that failed to find a predictable relationship between low back pain and common degenerative changes in the spine.
Bottom Line: Be skeptical of health care providers that point to degenerative changes on an imaging scan of your spine and say, “Ah, there’s the cause of your low back pain.”
For additional low back pain information, please see:
Spinal Arthritis
Degenerative Disc Disease
Low Back Pain
And, by all means, feel free to leave a comment or question below. I answer each one personally.
Dedicated to Erasing Your Back Pain
Malton A. Schexneider, PT, MMSc
The Back Pain Expert
8 comments ↓
Malton,, i am so releived to see that this may be true.. I beleive too many physcians are too quik to lay the blame for this pain on arthritic degeneration… I supposedly have a good deal of arthritic degeneration in my knee.. and not until I fell and tore the meniscus pad in two places anteriorly and posteriorly.. did I have crunching pain.or any deblilitating pain in the knee.. apparently, I have had degenerative arthritis in the knee for a long time.. I have been advised to have surgery to “trim” the meniscal pad.. or “repair” the tears? How does a surgeon “repair an area of the meniscus that has little or know restorative blood flow to it by surgery or sewing it together? The knee surgeon wants to “clean up arthritic damage” and to ” address the tears”.. what do you suppose that entails? I do know that now since the tears,, Ihave constant knee crunching pain.. unless under the influence of 400 mg of Ultram and two oxycontin.. 5 mg.. 8 hours apart?
[...] Arthritis and Low Back Pain | Sciatica | Back Pain | Sciatica … [...]
So I have worked in the physical therapy field for a while now. Except for one or two , the physical therapists I work with live and breathe by what the imaging reports say. With this being said, if degenerative changes are not the cause of the low back pain, what commonly is and why are so many health professionals insistent that the changes are the reason for the pain?
Steven,
You bring up an interesting observation - one that calls for further commentary (or ranting depending on your perspective).
The diagnosis of back pain presents a huge challenge for health care practitioners. The difficulty in arriving at a definitive diagnosis stems from the difficulty in establishing an unequivocal correlation between a patient’s subjective symptoms and objective findings obtained on examination.
It is far too common (and I have personally observed this) for a “diagnosis” to be based solely on the results of diagnostic imaging irrespective of the findings of the clinical examination. Because of their ubiquitous nature, it is easy to blame a patient’s clinical presentation of back pain on degenerative changes in the spine.
This exposure of the “obvious” tends to cloud some practitioners’ ability to treat the source of the patients’ problem resulting in a symptom-based treatment approach rather than a problem-based approach. And, in my opinion, this type of methodology is a monumental waste of time and money.
The medical literature (see references below) is quite clear on the following facts related to the diagnosis of back pain:
1. History and physical examination findings alone may be unreliable.
2. Imaging alone cannot differentiate patients with disc, facet joint, or sacroiliac joint related back pain from asymptomatic adults.
Fortunately, these “clinical-radiographic discrepancies” are being challenged by astute health care providers resulting in the identification of the underlying cause of a patient’s problem.
In the November/December issue of SpineLine published by the North American Spine Society, Bartanusz, et al presented 4 case studies where the patient’s signs and symptoms on clinical exam could not be explained by the imaging studies which identified moderate to advanced degenerative changes in the spine.
In each of the cases, these clinical-radiographic discrepancies led to the identification of unrelated disease processes ranging from early stage MS to spinal tumors elsewhere in the spine.
Physical therapists and physicians alike need to look beyond the “obvious” when evaluating and treating patients with back pain. For the results of imaging studies to dictate the manner in which treatment of back pain is rendered, a correlation MUST be established between the clinical examination and the imaging findings.
Thank you again for your comments and I encourage you to continue to ask, “Why?”
Malton A. Schexneider, PT, MMSc
Clinical Specialist
Orthopaedic Physical Therapy
References:
Coppess MH, et al: Spine 1997
Kuslich SD, et al: Proceedings of the 12th Annual North American Spine Society Meeting 1997
Schwarzer AC, et al: Spine 1995
Gilbert FJ, et al: Radiology 2004
Ito, M, et al: Spine 1998
Jarvik JG, et al: JAMA 2003
Jensen MC, et al: New England Journal of Medicine 1994
Sandhu HS, et al: The Journal of Spinal Disorders 2000
Boden SD, et al: JBJS 1990
Bernard TN, et al: Spine 1990
Horton WC, et al: Spine 1992
Zuckerman J, et al: Spine 1988
[...] Arthritis and Low Back Pain | Sciatica | Back Pain | Sciatica … [...]
so, i have had L4 & L5 fused back in 2007 which went fine for a few months and then i went back to hurting. of course after a few more MRI’s & a myelogram the doctor deemed it necessary to have a DCS (dorsal column stimulator) implanted due to possible scar tissue causing the pain. he did note that i have more bulging discs yet in another spot, but nothing notable to warrant another surgery. yet, with this stimulator pumped up i am still having the sciatica pain down my left leg. i am getting fed up not having a normal life due to this pain. i have joined a gym to hopefully get me back in shape and i know that it will definitely take time, but i am wondering if this is the right move. should i seek a second or third opinion or keep at the workout?
I recently started to get a pin in my buttock, & after 9 days it has left that area & worked its way down into the side of my thigh & knee. It use to help eleviate the pain to sit or lay down. Now I have constant pain & can barely walk a few feet. I saw a chirpractor twice & he is telling me it will eventually go to my foot & can take up to 8 weeks to heal…The pain keeps me awake all night. Seems to be getting worse. Any suggestions for the pain?
Sir,
Two-three weeks I lifted a ladder to my chest leaning backward to get onto a stand which I eventually did about half an hour later I developed a severe back pain which went away a week after home treatment, thee weeks later I HAPPEN TO MOVE MY UPPER body swiftly to the right I immidatelt felt severe pain in my lower back that has extended to the left and right side of my abdomen .
Please advise.
Randolph.
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