Over my thirty years of experience as a doctor of chiropractic, I’ve helped many people with low back pain.
Part of my job is making sure they understand how the low back works and what pain means. This communication challenge has been made more difficult because the typical medical testing process for low back pain is misguided. The process can actually distract people from the fundamental issues of low back health.
So here, in one place, is some of the important information I wish my patients understood.
Keep in mind that I’ve never examined or treated you. I have no idea what the specifics of your situation are. This article is for informational purposes only — to broaden your thinking process. There’s no substitute for consulting your own doctor.
1. Pain is an experience that takes place in the brain, not in the muscles, joints, or discs. This doesn’t mean that pain is “all in your head”. Pain has a tangible basis in the signals that are coming in from your body. Change the signals, and the experience of pain will change. Or change the way the brain processes the signals, and the experience of pain will also change. Even better, change both: the input and the central processing of the input.
2. The brain creates an interpretation of pain based on all the signals coming from the body – all the muscles, joints, ligaments, organs, etc. What that means is that only rarely is there a single site in the body you can point to and say “Aha! There’s the cause of the pain.” Instead, your body “computes” that you’re in pain based on the total picture.
3. Doctors often identify the intervertebral disc as the source of low back pain. This violates principle #2 in the paragraph above. But it’s not entirely crazy, either. Discs are subject to a lot of stress, and they’re rich with nerve endings – nerve endings that can send pain signals into the brain.
4. Nearly everyone over 30 – those with low back pain and those without — has some wear and tear of the intervertebral discs. And if you have an MRI, you’ll see it. The radiologist might call it degenerated, herniated, or bulging, or use some other term.
5. Since nearly everyone has some disc damage, the appearance of your discs on an MRI doesn’t correlate well with the amount of pain you’re in. It’s a tricky diagnostic situation. You can have really bad discs but little pain, or only slightly damaged discs and a lot of pain. You can also have pain on the side opposite to your disc bulge, or at a spinal level above or below your worst disc. The MRI shows the architecture of the disc, not the dynamics of movement or how your nervous system copes. It has limits as a diagnostic tool.
Move on to Low Back Pain, Section 2: research status