Are Scans Counterproductive for Back Pain?
Article by Lucas Rockwood
Lower back pain can be overwhelming and scary. You probably want your doctor to do an x-ray, a CT scan or an MRI so they can identify your problem and give you the right treatment. Unfortunately, in most cases, scans reveal nothing; or even worse, they reveal problems you didn’t know were there and were better off not knowing about. If this scenario sounds familiar, this guide is for you.
Consistently, the overuse of spine scans leads to worsened outcomes. A study reported in the British Medical Journal found a mere five to ten percent of spine scans revealed something pathological, and even then, the treatment options are usually the same and largely up to the patient to do on their own. In this guide we’ll explore why scanning isn’t always helpful for fixing lower back pain, how to self-assess the cause and key triggers of your pain, how to communicate with your doctor, and how to take full responsibility for your healing journey.
Most lower back pain resolves itself in six to eight weeks and, if you’re proactive with your healing, it can happen faster, and you can help prevent injury in the future.
Where is Your Pain Coming From?
Your focus with lower back pain management is to stay active and keep moving, but to avoid making the problem worse the first step can be defining and understanding your pain condition. This starts with attempting to discern muscle pain from disc pain or nerve pain.
Muscle Pain
- Often caused by heavy gym workouts, new movement patterns, sudden lifting, and torque movements
- Muscle pain is often generalised, rather than specific pain, which is often worse in the morning and when sitting
- Muscle pain diminishes almost immediately through movement, and day-by-day, you’ll notice big differences in reduced pain
Disc Pain
- Disc compression, dehydration, bulges or herniations are very common injuries related to activity or simply age
- Pain tends to be more localized, meaning you can often pinpoint the source
- Pain is often worse after sitting, but doesn’t diminish much with movement the way muscle pain does—it’s more steady
- Day-by-day, pain will reduce, but the reduction is not dramatic and healing is slow
Nerve Pain
- Nerves can be impinged by inflamed muscles or discs—or both
- Nerve pain tends to radiate down your butt or legs in your lower back or down your shoulder and arm in your neck
- Nerve pain can change throughout the day as the inflamed area impinging the nerve might go down as you move
- The feeling of tingling, numbness, or electrical pain is typical of nerve pain
- As the source of the impingement resolves, the nerve pain will resolve too
What Are Your Movement Intolerances?
To aid your healing journey, it’s important to identify which types of movements are restrictive. Try these common movements to test where your pain feels at its worst:
Forward Flexion Test
Imagine you’re reaching forward to tie your shoelaces. If you feel a sharp shooting pain, whether that’s the generalized muscle pain or a localized disc or nerve pain, that is your forward range of motion. Avoid this range of motion while healing and when you need to bend down, focus on bending your knees more. This will load your hips for more support and reduce the pressure on your back.
Spinal Extension Test
Extend your spine as if you’re moving into a back bend. Again, look for a sharp shooting pain when you find that area. Remember, what you’ve discovered are your guardrails for the next six-to-eight-week healing period – never push beyond this point.
Axial Rotation Text
This is much less common, but still worth looking at. Extend your arms and twist to the right, then repeat on the left. Do you feel pain in this range of motion? If so, back off this movement and don’t push to the point of pain during your healing period.
Compression Test
This is probably second most common painful range of motion after forward flexion. If you lift your heels and slam them down, how does that feel? What you’re looking for is a sharp, take-your-breath-away shooting pain, it might be localized or generalized.
Now What?
If you discovered you were lactose intolerant, you’d do your best to avoid milk, right? So, if you currently have a flexion intolerance, avoid that range of motion. While this sounds obvious, many people mistakenly assume if they push into pain, they’ll have a breakthrough. With back pain, this is not true. Keep moving but avoid your intolerant areas. Retest, and slowly move into greater ranges of motion over time.
What Are Your Movement Intolerances?
Studies show that 90 percent of back pain will resolve itself within six to eight weeks. This doesn’t mean you should flop on the couch and wait it out, because you don’t just want to heal, you want to heal strong and prevent reinjury.
Whether you have a herniated disc, spinal stenosis, or a simple muscle strain, the healing protocol is similar. Think about strength, stretching, flexibility, balance, and walking. Keep your movements gentle and considerate – never push into pain. If you can walk pain-free for 30 minutes a day, do that. If you can do some basic body weight strength training every day, and some stretching, do that carefully. Check out YOGABODY’s channel for some self-care videos to help heal back pain.
When To Ask For Help?
If the six-to-eight-week window passes and your back pain has not improved, or worse, it’s accelerated and is affecting your sleep or your ability to work, you need to see a medical professional. You’ll usually need to start by visiting your family doctor who might refer you to an orthopaedic surgeon, sports medicine doctor or physical medicine doctor. Avoid chiropractors and manual therapists. They are not medical doctors and do not have access to medical testing and interventions you might need.
How to talk to your doctor:
- Make it clear that your goal is to fix the problem and heal strong, in both the short and long term
- Doctors have amazing tools for pain relief such as cortisone shots and pain killers, but remember, those do not fix the underlying problem and come with potentially serious complications
- Surgeons have lots of options, but you should know that most surgical options are dubious and should only be considered after all other options have been exhausted
Safety Disclaimer
This article is for educational purposes only. If in doubt, or if you are living with long-term back pain, please check with a medical professional.
Research
pubmed.ncbi.nlm.nih.gov/30796513/
Want to Learn More?
- 21-Day Happy Back Challenge (on-demand)
- Lucas’s YouTube Channel (free to subscribe)
- The Lucas Rockwood Show Podcast
