MY BACK HURTS AND THE MRI SAYS I HAVE A BULGING DISC! WHAT NOW?
First of all...don't panic. The vast majority of people without back pain have bulging discs. In fact, a few studies were performed recently that looked a the images of necks and backs. All of the people involved in the studies were healthy and without pain. Below are graphical representations of the outcomes.
The study to the left examined the neck and the one to the right looked at the lower back. 80% of people over 30 years old have disc bulges in their necks and experience ZERO symptoms. In the lumbar spine, once you hit 40 years old there is a 50% chance you have a disc bulge and experience ZERO symptoms. And the numbers go up from there. What does all of this mean? More than anything, it means that there is a very good chance your disc bulge as seen on your MRI has absolutely no bearing on the pain and discomfort that you may be feeling. In fact, as you can see from the graph to the right, that there are many "negative" findings that are found in healthy, pain free subjects.
Lets define them:
Disc Degeneration (blue line): Basically degradation of the discs of the spine. It is not a disease, unless you call aging a disease. The water content of the discs dry out and the discs will be compressed
Disc Bulge (green line): A deformation of the disc when it protrudes further than the vertebral bodies. This is different from a herniated disc. In a herniation the walls of the disc are actually torn.
Disc Protrusion (yellow line): Very similar to a disc bulge however more severe. Depending on who you talk to or where you read, a disc protrusion is used interchangeably with a disc herniation.
Facet Degeneration (orange line): More or less this is arthritis of the little joints along the back of the spine
Spondylothisthesis (red line): This is a literal slippage of one vertebrae on another. (Not to be confused with "subluxation" which is another topic entirely.
These sound bad at face value, but many of them are normal occurrences that happen from aging and the fact that we live in an environment with gravity. I am not saying that MRI findings are not useful, but I am saying that when it comes to the spine and some of the findings above, they should be taken with a grain of salt. Before you panic about your MRI findings, make sure everything else is ruled out as a cause of symptoms. Are your hips tight? Are they weak? When was the last time you exercised? Is your back weak? What else is going on in your life? Are you stressed? Sleeping on an old mattress? Diet? These are all things to consider when looking at back and neck pain. Call your physical therapist of choice and discuss everything with them. They should have a plan of attack to help improve your pain and function. They can help you rule in/out what is going on. Cost of an average PT visit $75-100. Cost of MRI $3000! You could go to therapy twice a week for 3 months before reaching the cost of an MRI.....and most of the time it will only take a few weeks.
I'll leave you with this stat. People that get an MRI within the first 6 weeks of developing back pain are 8 times more likely to have unnecessary surgery.
THINK ABOUT THAT!
The AAFP (American Academy of Family Physicians) recommends NO imaging within the first 6 weeks unless there are specific red flags present. This is because of that fact above.