By Andrew Terry – Lead Osteopath at Bodylogics
I want to start this by saying that as an osteopath, I think scans such as X-rays and MRIs are extremely useful. If I have a patient come into my clinic with a suspected fracture, I will send them straight to A&E to get a scan. Osteopaths are fantastic at taking case histories, carrying out examinations and special tests. We’ve spent at least four years learning anatomy, physiology and various types of pathologies all so that we can come to the best working diagnosis possible. However, our hands are not X-rays, and there are times when we need to refer on to make sure there is not something more serious going on. It’s one of the reasons we take a detailed case history during your initial consultation, including asking you to bring in any scans you may have had, or any medications you may be taking. We take all this information, along with your symptoms, and try to figure out not only what is causing the pain, but why it happened to begin with. Essentially, we want to give you the best treatment possible, whether that is with us, or in some cases, with another healthcare practitioner.
However, whilst it’s extremely important that we see any scans you may have had, you may find that sometimes we do not agree with the link between the result of your scans, and the cause of your pain. But why is this? After all I just said a moment ago that our hands are not X-rays and we can’t see what’s happening underneath all your skin and muscles. Well, it’s because sometimes they produce red herrings. X-rays, MRIs, CT scans show us everything that is going on underneath all those layers. They may show us the wear and tear in your bones from when you played semi-professional rugby as an adolescent, or the impact years of bad posture has had on the curvature of your spine, and sometimes, all it shows, is the fact that our bodies are simply getting a little bit older. The problem with this is, is that there is not necessarily a link between the pain you’re experiencing, and the results of the scan. A comprehensive literature review published a few years ago looked into imaging features of spinal degeneration in people who were asymptomatic (those who had no symptoms). 33 articles reporting image findings for 3110 individuals, ranging in age from 20 to 80 years old were analysed. One of the findings showed that, even in 20 year olds, 37% had some form of disc degeneration, increasing to 96% in those over 80. That’s over 1 in 5 if you’re in your 20s, and you’re almost certainly going to have at least some form of disc degeneration if you’re in your 80s. Other common imaging findings were those who had some form of disc herniation. 29% of 20 years were shown to have disc protrusion that went up to 43% in those in their 80s.
Another 3 year cohort study published just a couple of days ago looked into abnormal lumbar findings in adolescent weightlifters. It found that children and adolescents could have irreversible changes to their lumbar spine and still be asymptomatic.
This is really important information for a number of reasons. The first is that aside from offering medication to help ease the pain, getting you to have a scan may be one of the first ports of call for your doctor. Whilst I must make it clear that I would never suggest going against the advice of your doctor, the problem with just giving out pain medication to those with back pain is that it doesn’t solve the problem, it just masks it. In fact, in some cases, as the pain is dulled down, you may in some cases actually make it worse as you go beyond what your body is capable of doing. And the medication alone won’t solve that disc degeneration. The other issue is that if so many of us have abnormal findings but show no symptoms, how relevant are the findings for those of us who do have symptoms? The answer is an old osteopathic favourite, and that is, it depends. For some of you, those findings will be extremely important, such as those with cauda equina. This is where nerves in your lower back get compressed, and if not dealt with fast, can lead to paralysis and loss of bowel and bladder function. Of course in these situations, we should all be very grateful that technology has progressed in the way it has.
But my issue with scans isn’t for these people, it’s for those who perhaps have had some type of degeneration or herniation all along, and yet for some reason or another, have just started experiencing discomfort or pain. In some cases, doctors will see the results of your scan and suggest surgery. The problem with this is, there is no coming back from surgery. In 2002 there was a comparative study of patients who had osteoarthritis in their knee. One group had a placebo arthroscopic surgery, and the other group underwent the real procedure. The placebo group were just as likely to report pain relief as those who had the surgery. So if the placebo group reported pain relief even though they just undertook a placebo surgery, then was it really the degeneration causing the pain? Perhaps not. At least in this study, both groups reported pain relief, but in some cases, patients have surgery, and yet are still in pain and discomfort post-operation.
Being told that we have degeneration in our spine can be quite scary. We start thinking there may be something seriously wrong with us, that’s it’s only going to get worse, or that our body is starting to give in. This just isn’t true, as is shown by all the people who walk around leading a perfectly normal and active lifestyle every day, completely oblivious to some of the things happening beneath the surface, from athletes to those who enjoy running. Pain comes from our brain, and as soon as we get told that something is wrong, we risk becoming that condition. We may get scared to make certain movements, or get overly worried every time there is the smallest of twinges. This in itself can be far more damaging, as we start to predict pain, and begin to form a bad relationship with our own body. As an osteopath, that is one of the things I try to prevent in my patients. That worry they can begin to get when they feel like their body is giving up on them. No matter what may be the matter with you, we must aim to have agency (or ownership) over our bodies and take back control. Whether it may be a bit of spinal degeneration, or slight arthritis in your knee, it’s not the end of the world, after all, no body is perfect.