There is good evidence that early referral to scanning for a patient with lower back pain is correlated with a poorer reduction in overall reported pain, and a longer recovery time (Ref: 1). It is also well known that asymptomatic individuals can have significant changes noted on scans (Ref : 2) that are better described as normal age related changes. But let's consider that you have had your scans and they describe a bulge, an extrusion, herniation or protrusion, and this picture has you very worried about the chances of a good non-surgical recovery. The question must be asked, “Can these disc changes reduce with more conservative actions, or is surgery required “?edit.
Concisely the answer is yes, that both clinically (ie: in practice) and academically(using repeat MRI's to review disc changes over time- Ref : 3 and 4), significant resolution of disc bulges and patient symptomology occurs with conservative treatment.
Sometimes surgery is required but increasingly it appears that more conservative measures such as physiotherapy and time, are being prescribed under certain circumstances, even in patients with quite severe presentations. The mechanisms as to why these disc changes can resolve is not completely understood, especially when mechanical loading or compression of the disc may oppose this process ( Ref : 5 ). One explanation is autolysis, which basically describes an autoimmune process whereby extruded disc tissue and inflammation, is recognised by macrophage cells and resorbed into the body. This leads to a reduction of the appearance of the disc herniation/disruption on MRI and decreased irritation of the spinal cord and nerves.
This blog does not attempt to provide a pathway for making a decision about the treatment of lower back pain but rather to provide hope, that conservative measure can be effective even for patients with more severe presentations. A full assessment by a qualified Physiotherapist or Doctor needs to be considered before appropriate management can be implemented. Treatment decisions for lower back pain are more complex than described above and the signs, and symptoms must be recognised for all of the other possible pathologies of the spine for better treatment of the patient.......our focus at Physiosense.
1: Of shiny pictures and poorer outcomes: Spinal MRI and back pain
2: Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populationshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/
3:Spontaneously disappearinglumbardisc protrusionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2529204/
4: Spontaneous Regression of a Large Lumbar Disc Extrusionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966735/
5: Conservatively treated massive prolapsed discs: a 7-year follow-up
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Jason is the Leichhardt Physiotherapy clinic practice principal. A graduate from Sydney Uni and practicing for 18 years he is passionate about sharing new discoveries.