BAILEY’S BIG 3: LETTING GO OF SCARY IMAGING RESULTS!

April 17, 2015

So the theme of April at Whole Therapy is “letting go.” I struggled with coming up with a blog topic to compliment this theme. This past week, however, I came across this article on the web and thought to myself, Eureka!  This is my teachable, “letting go” moment!

I want to preface by saying that medical imaging technology has developed into something amazing. The amount of stuff we can see without actually cutting into the body is phenomenal. Sounds morbid, I know, but it’s true! Medical imaging can be very valuable in identifying serious medical conditions such as fractures, dislocations, etc. That being said, it is often difficult to discern what findings on imaging are related to natural aging processes or rather a pain-provoking injury? Words like arthritis, degenerative discs, disc bulges, tendon tears all sound very scary! And the fact that they sound scary is a problem in itself. They can create fear- a lot of fear. But, what if I told you that the above are all minor findings and do not really add much value to your plan of care?

Confused? Let me clarify. Mrs. A came to see me at the clinic for a “MRIdisc herniation.” On my subjective intake, I asked Mrs. A about her pain. Mrs. A had NO PAIN. Confused, I asked Mrs. A about her ability to perform her day-to-day activities. Mrs. A had NO DIFFICULTIES performing any of her day-to-day activities. Now very confused, I asked Mrs. A about this suspected “disc herniation.” Mrs. A had a hysterectomy in which she had some complications. She had to undergo repeat CT Scans to make sure all was well and healing appropriately. It just so happened that a disc bulge was seen as an incidental finding on one of these CT scans. Nervous about this finding, Mrs. A sought out physiotherapy to treat her disc herniation, for which she had no pain, no loss of function and for all purposes, NO impairment!

The fact is, arthritis, degenerative discs, disc bulges and tendon tears are usually just a natural result of aging against gravity. Don’t believe me? Check out this recent article (2015!) summarizing a cross-sectional study looking at abnormal findings on MRI in the cervical spine (a.k.a. neck) in 1211 asymptomatic people (a.k.a. NONE of the 1211 people had ANY neck pain). You can find it here: http://europepmc.org/abstract/med/25584950\

Three things you should know about neck imaging:

  1. Everyone has disc bulges. This study found that 87.6% of the 1211 had disc bulges and no neck pain. So for every 10 people, 8.76 of them have disc bulges! And remember, none of these people had any pain!
  2. You even have disc bulges in your 20s. They found that 73.3% and 78.0% of males and females in their 20s had disc bulging. Yep, even your 20 something co-worker who barely seems out of the womb probably has a disc bulge.
  3. A small percentage of people even have spinal cord compression and no pain! Sounds unbelievable eh? But 5.3% of people, generally over the age of 50, had evidence of spinal cord compression with no pain. That’s not to say that the compression shouldn’t be monitored, but it goes to show you that the perception of pain is a lot more complicated then we may give it credit for!

Pain in itself is a complicated construct. I’m not trying to undermine anyone’s pain experience, but it is important to recognize that the scary-sounding results on imaging may not be so scary at all. Giving these words power over your life, however, has been shown to lead to more doctor’s visits, more pain, more disability, and a poorer quality of life. The only way to overcome this is to let go of the power we give these words and understand that they are probably just a natural result of aging! Don’t worry, you’re going to be just fine!

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey