Many people come in with what they are calling a herniated disc problem because they have pain in their back and pain in their leg and they think the disc is responsible.
Upon a physical examination, what we are finding out is that for many, this is a referral pain from a ligament meaning they have a sprain.
This is difficult for people to understand because they see the MRI, after they have been to the orthopedic surgeon or the neurosurgeon, they see a disc sticking out on the film, and I have have people with discs sticking out as much as 10 millimeters, and that would seem to be what is causing problems with pain, but it is not because it is not pressing on a nerve.
We know from studies that half the people after a certain age show disc problems on film but they reported they had no pain.
Researchers writing in The Spine Journal examined the relationship between new and serious episodes of low back pain and findings on MRI The researchers noted that common degenerative findings are often interpreted as recent developments and these common findings are often called culprit to the new symptoms.1
So if you have a sudden back pain, MRI may lead to more problems than benefit.
Let’s say someone tweaks a ligament in their lower back, usually the iliolumbar ligament, which connects the pelvis to the spine and they have an MRI done and it shows a herniated disc, their doctor is going to want to operate when it was not warranted in the many cases I see. That disc may have been herniated for years and had not been causing any pain.
Another study suggested that immediate, routine lumbar spine imaging in patients with lower back pain and without symptoms indicating a serious underlying condition did not improve outcomes compared with usual clinical care without immediate imaging. 2
And another study suggested “More than 85% of patients seen at primary care practices have low back pain that cannot be attributed to a specific disease or an anatomic abnormality and it is well known that imaging of asymptomatic patients often reveals anatomic abnormalities, such as herniated discs. One of the risks of routinely imaging uncomplicated acute low back pain is patient “labeling”; no evidence exists that labeling patients with low back pain with a specific anatomic diagnosis improves outcomes.” 3
So if someone has a diagnosis from an MRI the first thing we do is see if that is REALLY where the pain is coming from. To practice good medicine we need to rely on MRI, x-ray and CT scans. But we also need to use our hands to find out where the pain is coming from, being careful to gently press on the suspect area causing pain. When the physician’s touch elicits an intense pain spot, known as a trigger point or tender point, this may be a good area to do our regenerative techniques of Platelet Rich Plasma therapy and Prolotherapy.
Please see our article for more information about failed treatments for lumbar disc herniation.
Prolotherapy for herniated disc explained:
1. Carragee E, Alamin T, Cheng I, Franklin T, van den Haak E, Hurwitz E. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006 Nov-Dec;6(6):624-35. Epub 2006 Oct 11.
2. Andersen JC. Is immediate imaging important in managing low back pain? J Athl Train. 2011 Jan-Feb;46(1):99-102.
3. Srinivas SV, Deyo RA, Berger ZD Application of “Less Is More” to Low Back Pain. Arch Intern Med. 2012;172(11):1-5. doi:10.1001/archinternmed.2012.1838