Lower back pain – Is your X-ray or MRI doing more harm than good?

Do you have degeneration, arthritis, or disc bulges in your lower back?

The results of an X-ray or MRI can be frightening. X-rays and MRIs are meant to provide us with clarity about our diagnosis, but they often instill the belief that our body is fragile and broken resulting in uncertainty about our long-term spine health.

Statistically, many of you reading this have degeneration, arthritis, and disc bulges in the lower back. These issues become more common as we age similar to the wrinkles on our skin.

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It's common for your doctor, physical therapist, or chiropractor to use phrases like “wear and tear” to describe the spine.

Recent studies show that “wear and tear” and arthritis on X-rays or MRIs are not correlated to pain. In other words, some people with arthritis have pain and other people with arthritis have no pain; therefore, arthritis is not the main factor "causing" pain.

The results of these recent studies are changing the language that health care providers use with their patients. In place of "wear and tear", health care providers are using phrases such as "normal age-related changes" because arthritis is a normal age-related change.

In the clinic, we often see people with severe arthritis who experience no pain and people with no arthritis who experience severe pain; therefore, it's important to develop a rehab program based on your current abilities rather than ONLY from the results of the X-ray or MRI.

The X-ray and MRI are still important for screening serious pathologies; however, the majority of people with lower back pain have no red flags for serious medical conditions.

Is your X-ray or MRI doing more harm than good?

 

In many cases, the X-ray and MRI create more harm than good due to the fear-inducing language used to describe the results of the tests such as "degeneration", "bone on bone", and "wear and tear."

These words induce fear rather than confidence. The first goal of a rehab program to reduce lower back pain is to remove fear and restore confidence. Then, new beliefs and movement patterns can be established to help you reduce pain and feel better.

If you have arthritis and degeneration, you will always have it and that is ok. It's only one small factor that may possibly contribute to your pain. Regardless of the results of the X-ray and MRI, you will benefit from a rehab program focusing on the factors contributing to your pain which you can control.

To illustrate the benefits of a properly designed rehab program, here is the story of Heather and Ross. (Their story is a fictional example of what happens to many people in the traditional health care system).

Case Study: Heather vs. Ross

Heather

 

Heather injured her lower back while squatting at the gym. She had pain for 2 weeks then went to her doctor because the pain did not go away.

The doctor ordered an X-ray and it showed that she had arthritis and degeneration in her spine. Her doctor referred her to a physical therapist.

Heather went to physical therapy and received electrical stimulation, hot packs, and massage for her lower back.

She returned to her doctor because she still had pain and the doctor ordered an MRI. The MRI showed a disc bulge. Heather knew there was something wrong! Sure enough, she had a disc bulge. This must be the reason for her lower back pain! (Hint: It is not the reason).

Now, Heather is convinced the disc bulge is the cause of her lower back pain. She knows she will have a "disc bulge" for the rest of her life.

 

Ross

 

Ross is also dealing with lower back pain from lifting weights and squatting at the gym. He is 24 years old, strong, and he works out at the gym five days per week. He went to his doctor and the doctor ordered an X-ray. The X-ray shows arthritis and degeneration in his spine similar to Heather.

He went through an assessment at Evercore Physical Therapy. After an assessment, we identified weakness in his hip muscles and limited ankle mobility. These weak areas were negatively influencing his ability to lift weights and squat without pain.

Over several months, Ross and I work together on a progressive strength training program to build his tolerance to previously painful movements.

Ross avoided an MRI and he is now feeling better than ever! He may have a disc bulge like Heather, but it's irrelevant to his life. If he does has a disc bulge, it has no influence on his life.

Unlike Heather, Ross will live without the fear of knowing he has a disc bulge.

What is the difference between Heather and Ross?

Ross’s physical therapist focused on a strength training rehab program, and he was able to recover faster than Heather in addition to avoiding an MRI.  Heather’s physical therapist focused on passive modalities like electrical, stimulation, hot packs, and massage. These techniques felt good at the time, but they did not help Heather in the long run.

Heather demanded an MRI because physical therapy didn’t help her. The MRI showed a disc bulge; however, the disc bulge was not the cause of her lower back pain. Now, she feels anxious that her disc bulge will get worse.

As mentioned before, MRIs are an important part of healthcare, but they often create more fear and anxiety when they reveal "arthritis", "degeneration", and "disc bulges." These issues become more common with age and they are not always contributing to pain.

The research shows that many people who have arthritis, degeneration, and disc bulges can still live a pain-free, active life without surgery, injections, or pain medications.

If you have degeneration, arthritis, or a disc bulge then be hopeful that you can restore your spine health regardless of a “bad”  X-ray or MRI.

In addition, we will show you examples of exercises that promote healthy movement patterns for Ross and Heather. These five exercises will benefit those who want to continue weight lifting in the gym after lower back injuries.

Prior to trying these exercises, consult with your physical therapist.

Exercise #1: Hip Hinge.

Exercise 1 - start

Starting position: The stick should  have three points of contact in the standing position: the back of the head, the upper back and the butt.

Exercise 1- end

End position: You should be bent forward at the waist the stick keeping contact with all three points.

Instructions:  Place a stick behind the back with the head, upper back, and pelvis touching the stick. Hinge at the hip and lean forward at the trunk while maintaining the spine straight.

 Helpful Tips: Maintain contact with the stick. If the spine bends, then you will lose contact with the stick.

Where should you feel it? You may feel the muscles in the lower back and spine. You may also feel a stretch in the back of your thighs or calves.

Why should you do it? This exercise strengthens the muscles that support the spine. It also teaches you how to hip hinge correctly. The hip hinge is essential to squatting and deadlifting properly. Those who don’t squat or deadlift at the gym still need to practice the hip hinge technique because this is a basic movement performed in everyday activities.

Exercise #2: Staggered stance hip hinge.

Exercise 2 - Start

Starting position: Standing upright with one foot in front of the other foot.

Exercise 2 - end

Ending position: You should be bent forward with the spine in a straight position.

Instructions: Place one foot in front of the other and perform the same movement as exercise #1. Use the hip hinge movement to lean the trunk forward while maintaining the spine straight. The starting and ending position of the spine are the same.

Helpful Tips: Try to avoid bending or rounding the lower back. As the exercise becomes easier, lift the back foot off the ground.

Where should you feel it? You may feel the muscles in the lower back and spine. You may also feel a stretch in the back of your thighs or calves.

Why should you do it? This exercise places more demand on the muscles that support the spine. It’s a harder version of the hip hinge exercise since the feet are staggered. This exercise transitions you to a single leg Romanian deadlift (single leg RDL) as the back foot is lifted off the ground.

Exercise #3: Bridge with clams.

Exercise 3 - start

Starting position: Lie on your back with an Evercore miniband around the thighs.

Exercise 3 - end

Ending position: The hips should be lifted upward with the knees pushing into the Evercore miniband.

Instructions: Lie on your back with a heavy (blue, gray, or black) Evercore miniband around your thighs. Lift the hips up with the knees together to perform the bridge. At the top of the bridge, bring the knees apart, back together, then lower the hips to the floor. Repeat.

Helpful Tips: Try not to hyperextend the lower back while bridging. Focus on your mind-muscle connection by squeezing the glutes during the entire movement.

Where should you feel it? You will feel this in your glutes, hips, and lower back. You should mostly feel it in your glutes. Use a heavier resistance Evercore miniband if you don’t feel it.

Why should you do it? This exercise strengthens the glutes and hips which help to support the spine. This exercise combines two of the best exercises to strengthen the glutes: the bridge and clam. If you want to look good and feel good, then start doing this exercise.

Exercise #4: Cat Cow.

Exercise 4 - start

Cat position: Keep the knees hips under the and round the spine.

Exercise 4- end

Cow position: Try not to rock the hips back like this photo. The lower back should arch with the hips in the same starting position.

Instructions: Start in the hands and knees position with the hands under the shoulders and hips under the knees. Start with the lower back in a neutral position then move into the cat position by rounding the lower back and tucking the pelvis under you. Next, move into the cow position by reversing the movement and arching the lower back.

Helpful Tips: Try to stay in a comfortable range of motion. If you have lower back pain, you may only be able to perform small movements. It’s fine if you are moving at 25% capacity because your range of motion will improve over time.

Where should you feel it? You may feel this exercise in the lower back. If pain is present, then try to stay in a comfortable range.

Why should you do it? This exercise improves mobility in the lower back and hips. It helps to reduce pain by desensitizing the lower back to previously painful movements. Your brain may be interpreting these painful movements as harmful, but they are not likely harmful. This exercise is a safe way to start moving again.

Exercise #5: Press-ups.

Exercise 5- start

Starting position: Lie on your stomach with the hands under the shoulders.

Exercise 5- end

Ending position: The elbows should be straight and the lower back should be arched.

Instructions: Lie face down with the hands under the shoulders. Straighten the elbows and perform the press-up movement. Relax the lower back and leg muscles as you press-up.

Helpful Tips: Initially, press-up half way. Then, try to press-up further with each repetitions. By the 10th repetition, you should press-up near your full capacity; however, you should stay within a comfortable limit. Pain should never increase down your leg. If it does, then stop.

Where should you feel it? You will feel this exercise in the lower back. If pain is present, then try to stay in a comfortable range. You may also feel a stretch in your abs or the front of the hips.

Why should you do it? This exercise is one of the most important exercises to reduce lower back pain and sciatica. Most people respond well to this exercise. Of course, each person is different and you may require different amount of movement. If you need additional help with lower back pain, then consult with a physical therapist.

Watch this video for additional instructions with these exercises:

Are these the only 5 exercises for spine health?

These exercises are 5 examples of the many exercises that can be beneficial for long-term spine health. If I am working with a client, I often incorporate variations of these exercises into their program; however, I need to modify these movements based on their fitness level.

For example, one person may need to progress to a single leg bridge because the regular bridge is too easy. For others, the single leg bridge is too challenging and we need to stick with the regular bridge for several weeks before progressing to the single leg bridge.

These 5 exercises have helped many of my clients; however, your rehab program should be specific to your situation.

How can you start an exercise-based program for long-lasting spine health?

As mentioned before, I recommend you find a good, local physical therapist who focuses on a strength training rehab program.

There are different types of physical therapists with different specialties. Choose a physical therapist who has experience helping people with similar characteristics as yourself. Ideally, someone who you know, like, and trust.

I would recommend a physical therapist certified in the McKenzie Method. If you are still having lower back pain, then consider joining one of our free support groups below.

Excessive systemic inflammation is a major source of chronic lower back pain. People who switch to an anti-inflammatory diet often have less pain. As you know, doctors usually prescribe NSAIDs like Ibuprofen or Diclofenac to reduce pain and inflammation; however, these medications can increase the risk of heart attack and stroke.

As an alternative, you may want to try Turmeric Extract, not Turmeric Powder. Turmeric Extract helps to promote a healthy inflammation response in the body which can potentially reduce pain and inflammation. You can learn more about it below.

We recommend Active Atoms Turmeric Extract to promote a healthy inflammation response in your body:

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