Brinjikji et al 2015 Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
Low back pain is the leading cause of disability in Americans under the age of 45 and the most common physical condition leading to doctor visits. Many new studies are now questioning the causative role of disc herniations, osteoarthritic changes, and spinal stenosis in low back pain. Results show that although association is high, causality is low. One study divided people into two groups: one with a long history of low back pain, the other with no history of pain. When researchers compared X-rays, MRI’s, and CT scans there was no physical difference between the pain and non-pain groups. In fact, the spinal pictures of the non-pain group often looked worse. Because of this many orthopedists and neurosurgeons are now learning to treat the patient, not the picture.
Some doctors now recommend two years of physical therapy before getting any kind of surgery on the back. In 2006, The Journal of the American Medical Association found that over this period of time, patients with low back pain and leg pain improved nearly as much as those who went under the knife, with differences in outcome described as “small and not statistically significant.”
As we come to accept that our bodies begin to breakdown with age, an increase in pain doesn’t have to be part of this breakdown equation. The table above, from a study published in the American Journal of Nueroradiology, shows that although one-third of adults over 20 show signs of herniated disks, statistically only 3% of these disks actually cause symptoms.
So if low back pain is not a problem with the skeletal structure, it is most likely a problem with the soft tissues of this area. Getting massage from a well trained and therapeutically-minded massage therapist, coupled with low stress aerobic exercise such as walking or swimming could relieve your back pain without the high cost of surgery.
Interested in further reading and listening? Check out this Time Magazine feature, this New York Times article, or this NPR show.