Imaging Tests For Lower Back Pain: No Cause For Alarm?


One of the most common concerns patients have when visiting a physical therapist is in regards to the imaging findings from X-rays and MRI’s of the low back.  Often times these scans can show a variety of issues that can be alarming to see – words such as “stenosis”, “degenerative disc”, “bulge”, “protrusion”, or even the dreaded “spondylolisthesis”.

These words alone can be scary if you’re suffering from low back pain.  This fear can make us hesitant to move, bend, walk, or enjoy our normal daily routine.  In fact, things like fear and distress have been shown to be better predictors of who will have more persistent pain than your MRI findings.  And unfortunately, unexplained imaging findings can directly increase fear and worry, and thus your pain!

Low back pain is no fun, but is for the most part a benign problem – that is, it is not life threatening.  Some of the most common questions regarding low back pain and imaging findings are “Is this normal?” and “Is it safe for me to move?” For the vast majority of low back pain, the short answer is YES!  And here is why.  There has been a ton of research done on X-ray and MRI findings in low back pain – and the results are actually very positive.

A recent systematic review conducted by Brinjikji looked at how often MRI findings show up in people who don’t have any back pain.  What they found was pretty cool:

Over half of everyone over the age of 30 shows disk degeneration, 50% of people 40 and older show disc bulges, and as we age all of these become prevalent – but pain doesn’t have to come with them!

This information is often important to people who are dealing with low back pain – imaging findings can be scary if we don’t understand how common they are or what they mean in the grand scheme of things.  One thing I often tell patients is that disc degeneration in the spine is as common as gray hair – and just as dangerous!  So the next time you see an X-ray report that says “signal height loss” – that means you’re normal!

The next question people usually have is this:  “If my MRI scans show nothing out of the ordinary, then why the heck does my back hurt?”  Researchers call it “non-specific low back pain” which means we can’t identify a specific cause for why you are hurting – we just know it’s not something life threatening.  The good news is that there is a lot you can do about it, and Physical Therapy can help – getting you on an individualized movement and exercise program can help get you back to those activities important to you quickly.

Of course, there are certain times when imaging findings reveal something more serious – or when low back pain is accompanied by a loss of strength in the legs or even loss of bowel or bladder control.  If you notice this it should be brought to the attention of your Physician or Physical Therapist as soon as possible.  Fortunately these issues are relatively rare – and Physical Therapists are trained at identifying these red flags.

If you are experiencing low back pain and are concerned that there is something serious going on – give your Physical Therapist a call.  Many times a free injury screening can give you reassurance that nothing more serious is going on and all you need to get back in the saddle(or off the couch, as the case may be).

Written by Ryan Appell, PT, DPT, Silver Lake Physical Therapy

Source:  Brinjikji, W.  Luetmer, B. Comstock, BW.  (2014) Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.  American Journal of Neuroradiology.  

Ryan Appell, PT, DPT