A Physiotherapist’s answer:
This week we are talking about spinal degeneration and your concerns about changes that might be happening in your back.
Maybe recently you have had some back pain and have been referred to receive imaging or an x-ray at your local radiology center/ hospital. You’ll then go back to your GP who will advise you that you’ve got maybe some level of disc degeneration, disc signal loss, thinning of discs, a protrusion, facet degeneration, the list goes on.
Whether or not you decided to find your answer after googling it due to the cold sweat and fear your health professional gave you by reading your scan results, or if you were just curious what you could do about it, here are my thoughts.
So here are a few key points relating to how you can re-frame things into perspective.
As Physiotherapists, we treat your limitations- not what is written on a piece of paper.
We work hard to find out what your personal goals are and any limitations that you might have. Using that information, we formulate a plan with you to address those concerns, using whatever appropriate means and tools we have as Physiotherapists, whether it’s soft tissue therapy, exercise, education, modification to your activities, etc.
Research has shown that asymptomatic (no symptoms) subjects scans revealed the following:
What the results found is that "most subjects presented with disc bulging (87.6%), which significantly increased with age in terms of frequency, severity, and number of levels. Even most subjects in their 20s had bulging discs, with 73.3% and 78.0% of males and females, respectively" (Nakashima, et al., 2015, p.392).
That means regardless of if you have pain or not, people are naturally getting these changes occurring in their spines. This is a normal ageing process and not a disease.
One of the most reassuring descriptions I’ve heard for describing degeneration is:
It’s like white or grey hairs. You’re going to get them, and it’s OK!
Now, does that mean imaging and scans aren’t useful at all? No, when there are symptoms and pathological concerns, imaging can be very necessary. However, at this time there is poor evidence and overall use for X-Ray imaging for basic, musculoskeletal pains. The evidence is also getting stronger, and it is evident that routine imaging is not necessary in the process of ruling out problems.
To summarize, remember that your scan cannot be interpreted at face value. Treat your symptoms and limitations, not your scan.