Tag Archive for: mri

How Back MRI’s Lead to more Invasive Treatments and Surgery

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If you’ve ever suffered from acute or long-standing back pain, you’ve likely wanted to “see inside” and know what’s going on. If this is you – you’re not alone in your thinking – and many medical doctors agree with this approach. However, evidence suggests that unwarranted MRI’s on your back can lead to unnecessary invasive treatments and surgeries, which often result in more harm than good in the long-term.

Let’s take a look at the research.

As part of their International Choose Wisely Campaign, the BMJ (British Journal of Medicine) published findings of a 2020 study that investigated what happens when back pain sufferers get MRI’s done too early (defined as less than 6 weeks into an episode and absent of any red flags). In more than 400,000 patients, those who received early MRI’s on their back were more likely to undergo back surgery and be prescribed opioids. And worse – they had higher pain scores at 1-year follow-up than those that didn’t get an MRI. This is not an isolated study. There is mounting evidence that indicates when MRI’s are done too early or unnecessarily – it leads to more surgery, more invasive treatments, more negative perceptions and catastrophization of spinal conditions, and overall – poorer outcomes.

So when is a back MRI needed? 

When you’ve got any alarming symptoms (known as “red flags”) you should absolutely get an MRI. These include signs of cancer, infection, inflammatory disease, possibility of fracture, or severe neurological deficit. Qualified health care practitioners are trained to identify these red flags. However, they are seen in only about 5-10% of all back pain cases. For context, in my two decades of treating patients with back pain, only three had these serious symptoms. This isn’t to downplay severe back pain cases, but to emphasize that most back pain patients don’t need an MRI for a proper diagnosis and treatment plan. And if you get an MRI when you don’t need one – you might end up with unnecessary treatments or surgeries, be prescribed opioids, and are likely to feel generally worse about your back pain.

The problem with relying on back MRI’s

When you get an MRI of your back – the problem is it shows you everything.

You’ll see a comprehensive view of bulging discs, arthritis, stenosis, and degenerative discs – which are all common findings – but also a normal part of aging. Everybody gets them whether you have back pain or not. But because we haven’t done a good enough job of normalizing these findings – they often get blamed for your back pain when seen on an MRI. But the research shows you can’t reliably correlate your MRI findings to the true cause of your back pain. In fact, they’ve compared MRI’s of people with and without back pain and found they can share almost identical results. In a set of publications known as the Lancet series, Martin Underwood, MD, co-author and professor at Warwick Medical School, said: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Confused? I don’t blame you.

The truth is, about 70-80% of all back problems, even sciatica, are considered what we call “mechanical” in nature. Your pain will come and go, you’ll have good days and bad days, and you’ll often feel better with movement. Mechanical back pain cannot be diagnosed by an MRI – it’s diagnosed via repeated movement testing to see what triggers and relieves your back pain. And it’s treated with corrective movement strategies designed to get rid of your pain and keep it gone. If you undergo an MRI for what’s essentially mechanical pain, you risk receiving treatments that are not only unnecessary, but can exacerbate the problem. Remember, you can’t reverse a back surgery. And complications related to back surgery are complicated to treat. You owe it to yourself to exhaust all possible conservative treatments.

If you’ve been suffering with back pain for years, I know it’s frustrating.

Consider speaking to a mechanical back pain expert who can help you accurately determine the root cause of your back pain with corrective movement strategies instead of a back MRI.

Give yourself a chance to resolve your back pain naturally instead of resorting to invasive treatments or procedures.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or request a seat in her upcoming Masterclass for Back Pain & Sciatica – visit her website www.cjphysicaltherapy.com or call 603-605-0402

orthopedic surgery

Three Science-backed Reasons not to Rely on Imaging for Orthopedic Surgery

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Approximately 7 million people undergo an orthopedic surgery each year in the United States. Topping this list are elective procedures (meaning they are not life threatening or urgent) such as ACL reconstruction, total hip and knee replacements, arthroscopic surgery (meniscus repairs, shoulder decompression, etc), and spinal fusions.

Now, what if I told you that of the top 10 elective orthopedic surgeries performed, only one (carpal tunnel syndrome) has real evidence to support that surgery will have a better outcome than conservative care. A recent study published by scientists in the UK hospital system and National Health service reviewed thousands of published studies in an effort to find out if orthopedic surgery was truly better than conservative care or placebo procedures. They found that sadly, thousands of patients are undergoing invasive procedures every year with known associated risks and complications. All while there was an equal or better alternative.

One of the biggest reasons this happens is because people rely on imaging (X-rays, MRI’s, CT scans) to determine whether or not they need surgery. Don’t get me wrong, this incredible technology has revolutionized the field of medicine and orthopedics. The problems occur when we fail to look at the full picture (no pun intended) and rely on images alone to make important decisions about our musculoskeletal health.

Here are three science-backed reasons not to rely on imaging alone when considering orthopedic surgery:

 

1. Imaging does not always correlate with symptoms

One of the most fundamental reasons why imaging alone should not dictate your decision to get orthopedic surgery is the well-documented lack of correlation between image findings and actual symptoms. 

Studies have shown that 20-25% of all people will show a bulging disc in their spine on MRI. This happens even when they don’t have any back pain. At least 50% of adults over the age of 50 will show torn meniscus or cartilage in their knees and feel completely fine. In 2013, The New England Journal of Medicine published a study that found one-third of participants with no knee pain had “abnormal” results in their imaging. This was while one-half of the participants who actually experienced knee pain had completely clear scans. 

We have to start normalizing what aging actually looks like on a scan. Just because you’ve got a bulging disc, torn cartilage, or even “bone on bone” arthritis – it doesn’t mean you need to rush into the operating room.

2. Risk of Over-diagnosis and Overtreatment

Overdiagnosis refers to the identification of conditions that aren’t actually causing symptoms or harming a patient. The biggest culprits here include spinal stenosis, joint arthritis, and degenerative joint conditions. One notable study from 2017 published in PLUS ONE, a peer-reviewed mega journal, found that at least 20% of arthroscopic knee surgeries were overdiagnosed and subsequently overtreated. How did they now? Because even though their scans showed things like “wear and tear” and torn cartilage, they had no relevant dysfunction or clinical findings. The only thing indicating they needed surgery was the overdiagnosis of normal aging in their knee.

A particularly sad story comes to mind as I write about this. I recall treating a man with spinal stenosis who was told by his doctor he needed steroid injections to calm the inflammation in his back. He had 6 weeks until his injections, and during that time, we were able to decrease his pain by about 80%. Since it’s impossible to reverse or stop spinal stenosis without surgery (because it’s related to wear and tear as you age), I knew that his pain was being caused by other unrelated factors. But following doctor’s orders, he still went through with the injections. Unfortunately, he had a bad reaction to the injections that left him worse off than when he started with me. His over-diagnosis of spinal stenosis led to a cascade of over-treatment and worse pain than when he started. 

3. Non-surgical treatments can be equally effective (if not better)

Orthopedic surgery should really only be considered as a last resort. No matter how routine or “non-invasive” the surgery is, there are still risks of infection and complication, and you want to avoid those at all costs. The problem with conservative treatment is that it takes longer to get to the same (or better) result. And let’s face it, we live in a quick fix world and rarely have patience for this, especially when you’ve got a scan that seems to say otherwise.

Study after study shows that arthroscopic knee surgery (in particular) has the same or better results when treated conservatively (physical therapy and exercise). In fact, when you get arthroscopic surgery on your knee, it increases the likelihood you’ll need a total knee replacement. With back surgery, we know that in the first year or two, your pain will be better or gone. But by year 2-3, if your symptoms haven’t crept back in yet, you’ll feel just as good as your peers who forewent surgery. But after year three, your back pain symptoms tend to return, and you’ll often feel worse than your friends who decided to take the conservative approach from the get-go.

The research continues to support that 70-80% of all musculoskeletal pain is mechanical in nature. Mechanical problems have to do with movement dysfunction and lifestyle/postural habits. They don’t show up in a scan, and they are best treated conservatively. When you see something on an image, it’s better to assume it’s irrelevant and that you fall into the 70-80%. This will protect you from being overdiagnosed and help you avoid potentially unnecessary procedures and surgery. Pay attention to your pain, symptoms, and overall function – they tell a much better story than your images.

Are you local to Portsmouth, NH?

Consider seeing one of my Specialists – they’re experts in mechanical pain. In a free Discovery Visit you can tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. It’s a no-obligation appointment that will give you all the information you need to make the BEST decision for YOUR health. Whether that’s working with us or not!

CLICK HERE to request a Free Discovery Visit.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

knee pain source

When Knee Pain Doesn’t Go Away – Consider your lower back.

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One of the most important things to get right when it comes to successfully resolving knee pain is to correctly identify the knee pain source.

Is your knee pain actually due to a problem in your knee? Or is the root cause of your knee pain coming from somewhere else in your body?

Rosedale, et al published a study in 2020 that revealed 43% of all isolated extremity pain was coming from the spine. What that means is that you could have nagging knee pain, and no back pain at all, and your knee pain is the result of a lower back problem. I’m not going to get into the technicalities of how this happens. Generally speaking, it’s a mechanical problem in your lower back that causes irritation to nerves or structures that impact your knee – and only your knee.

But how do you know for sure?

One of the biggest clues you’ve missed the root source of your knee pain is that it doesn’t go away after trying everything that “should” help it. Perhaps you’ve tried ice, heat, pain medication, foam rolling, strengthening, and stretching. Even physical therapy – but no matter what – your knee pain just won’t go away. It might get better for a short period, but it always comes back. If the lower back is not considered at this point, then it’s typically when knee doctors get involved. This is great if you’ve actually got a knee problem.

Knee pain that doesn’t respond to conservative treatment should be looked at further. But if your knee pain is a symptom of a problem in your lower back, and it’s missed, you risk having an unnecessary knee procedure or surgery that will only cause you more problems later.

Here’s a quick story about someone this happened to…

I spoke to a client the other day – we’ll call him “David”. He had surgery on his knee to clean out some cartilage and wear and tear from arthritis. They recommended this surgery because he had “failed” regular physical therapy treatment. Nothing else seemed to be resolving his knee pain. It was supposed to be a “quick recovery” and take his pain away because they assumed all his problems were due to arthritis. Well, three months later, Davids knee felt (and functioned) worse than pre-surgery. Now he had back pain to go along with it. To fix the new pain he was having they were recommending even more knee surgery. And now they wanted to do an MRI of his back.

How does something like this happen?

The biggest culprit is over-reliance on imaging to form a diagnosis and treatment plan. Leading you to have the wrong idea of your knee pain source.

If you’re over 50, and you get an X-ray or MRI taken of your knees, there is a 60 to 80% chance they’ll find arthritis and/or meniscus (cartilage) tears. And this will be whether you have knee pain or not. That’s because these are normal changes that occur as you age.

So if you’ve got knee pain, and your doctor wants to do some imaging, there is a very good chance they’ll find one or more of these changes in your knee. They might just blame your knee pain on it without looking at anything else. That’s exactly what happened to David. They blamed knee arthritis for his knee problem when it was actually coming from his lower back.

How do I know?

Luckily for David, he refused the second knee surgery. He went to a mechanical pain expert for diagnosis and treatment, and in 2 months both his knee and back pain were gone.

Do you have knee pain that won’t resolve with typical knee pain treatment? You must consider that it could be coming from your lower back before you undergo any kind of surgery or procedure.

If your knee pain seems to come on slowly or out of nowhere, if you have trouble pinpointing exactly where the pain is, if it moves around and changes from day to day, or if it runs up or down your leg – there is a good chance your knee pain is a symptom of a mechanical problem in your lower back and you should get it looked at.

Sciatica

Suffering from Sciatica? The Do’s and Dont’s

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Four out of five people will experience a debilitating back pain and Sciatica episode at one point during their lives. Sometimes this looks like severe back pain that lasts a few days and eventually goes away on its own.

But for some – especially those that have experienced more than one debilitating back pain episode over the course of their lifetime – they experience searing pain down their leg that may or may not persist over a period of time.

When you experience back pain followed by radiating leg pain – this is known as “sciatica”.

Sometimes the pain will only go to your knee, or be a dull ache in the side of your hip and leg. But other times it can manifest all the way down to your foot and be accompanied by numbness, tingling and a loss of strength.

The good news is that there is plenty you can do on your own to help yourself recover from sciatica naturally. But there’s just as much you can do – unknowingly – to make your situation worse.

Here are some Do’s and Don’ts when it comes to sciatica.

The Dont’s:

1. Avoid resting in bed or on the couch.

While it may feel better in the moment – lying in bed or on the couch will ultimately aggravate your sciatica. Sciatica is caused by pinching or irritation of the nerves in your lower back. When you lie in a slouched posture (such as in bed or on the couch) you will put unwanted pressure on these nerves, thus aggravating your symptoms.

The trickiest part about this is that you typically won’t notice the aggravation when you’re resting. You’ll notice it after the fact when you stand up or try to move around, and mistakenly assume the movement is what’s aggravating you instead of the relaxed posture you were just in.

2. Avoid child’s pose and stretching forward.

This is another big misconception about sciatica because it tends to feel really good when you’re “in the moment” and stretching your back forward. Not always, but often, sciatica is caused by a bulging or herniated disc that is pinching your nerve.

The position of bending forward does temporarily relieve pressure on your nerves – which is why it feels good at first – but it doesn’t last.

Stretching forward also opens up the space between your vertebrae. This can influence the protrusion (bulging) of your disc. If you allow your disc bulge to protrude more onto that nerve – your nerve will become more angry and aggravated – as will your sciatica.

3. Don’t let your MRI decide treatment.

As I mentioned in our first two examples, sciatica often involves bulging discs and irritated nerves. And an MRI will typically confirm this. But here’s the thing – tons of people out there have bulging discs showing up on their MRI’s and no symptoms at all.

What matters is whether or not your bulging disc is interacting negatively with your nerve – and that is typically influenced by poor movement strategies.In other words, if you learn how to move better, you can actually make your bulging disc inconsequential and your sciatica will dissipate.

So you should never let your MRI, alone, determine your treatment protocol when you’re suffering from sciatica. What’s more important is how your sciatica symptoms behave during movement. Research has shown this to be more reliable than imaging alone because it tells us in real time what’s happening to your nerves.

The Do’s:

1. Keep moving.

While it may seem counterintuitive to move when you’ve got pain running down your leg – it’s one of the best things you can do.

Try to stand and walk upright as much as you can and pay close attention to what happens in your leg. If the symptoms in your leg start to subside, then you’ll know that your body is enjoying that particular movement and that it’s helping your sciatica.

But here’s the catch – make sure the relief lasts. Lasting relief (vs temporary) is what we’re looking for and it tells us if the movement you’re doing is a good thing for your sciatica.

2. Watch your Posture.

This may seem trivial – but maintaining good posture is critical when you’re suffering from sciatica. Remember that sciatica typically involves a pinched or irritated nerve – and irritated nerves are highly sensitive to postural changes in your lower back (especially slouched postures).

Whether you’re standing, sitting, or lying down – be sure to maintain a small curve in your lower back to minimize your slouch. This helps to keep pressure off your discs and already aggravated nerves.

3. Talk to a Movement Specialist.

While it’s entirely possible to rid yourself of debilitating sciatica without pain pills, procedures, or surgery, you’ll find it easier to do so under the guidance of a movement specialist who specializes in understanding back pain and sciatica.

Yes – you can get an MRI and go see a surgeon – but they aren’t movement specialists. They are surgical specialists. In order to get rid of your sciatica the natural way (with corrective movement strategies) – you need to work with someone who’s an expert in this.

Have you been dealing with back pain or sciatica? Or do you know someone who is?

If you”re local Portsmouth, NH, and you want help NOW for your back pain – Request a Free Discovery Session from one of my specialists. They’ll tell you if we can help and get you set up on a treatment plan right away!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Back Surgery

Back Surgery: Why it fails and do you need it

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Approximately 500,000 Americans undergo back surgery to relieve their pain every year, and according to the Agency for Healthcare Research and Quality (AHTQ), this costs approximately $11 billion annually.

But what if I told you that only 5% of people undergoing back surgery actually need it – and worse – for many folks the pain ends up coming back. The American Society of Anesthesiologists estimates that 20-40% of back surgeries fail. If you’ve had repeated back surgery your risk of failure increases. Failed back surgery is so common that it’s gotten its own name – “Failed Back Surgery Syndrome” – which occurs when you experience continued pain in your neck, back, or limbs following any spine surgery meant to reduce pain.

So why then do we continue spending so much money on back surgery when the majority of people don’t actually need it – and when half the surgeries fail?

Back pain can be excruciating, debilitating, and have a significant impact on your quality of life and happiness.

If you’re in this situation, and told by a well-respected surgeon that surgery is your best option of taking your pain away and getting you back to living your life again, odds are good you will take that opportunity. And most of the time – surgery does take your pain away – initially that is.

But what surgeons don’t tell you is that your pain has a high likelihood of returning.

If you’ve had one “successful surgery” – you assume the next will go the same. But as mentioned above – the more back surgeries you have – the more likely they are to fail – and the vicious cycle begins.

So when should you get back surgery?

If you’ve had an accident or trauma that has resulted in major damage to your spine – you need surgery.

If you have urgent compromise to one of your spinal nerves you also need surgery. But let me preface “urgent”.

Your symptoms will be progressive and severe.

Signs might include problems with your bowel and bladder, sudden and worsening foot drop (loss of strength and ability to lift your foot and toes), walking will be difficult and progressively worsen, and nothing will take your pain away – medication and rest will barely touch your symptoms.

These cases are rare – but do require surgery to quickly decompress your nerve before permanent damage ensues.

But 70-80% of the time, back pain is what we call non-specific or mechanical.

And surgery is not recommended – and rarely works for this type or back pain.

Mechanical back pain can be acute and last for a few days, or can be chronic and come and go. You might have nerve pain with numbness and shooting pain down your leg, but it won’t be urgent like the situation described previously. The pain you feel is typically caused by irritation to soft tissue structures, discs, muscles, and joints. But the root cause of this irritation is from something different – and that is what we need to care about.

It’s why 50% of back surgeries fail.

Let me explain…

When you get an MRI to see “what’s causing” your back pain – it will typically show some form of bulging disc, degenerative discs, or lumbar stenosis. You will likely be told that these findings are what’s causing compression and irritation to your nerves.

They might try injections and medication first, but when that doesn’t work, they’ll recommend surgery. But here’s the catch. These findings show up in 60-80% of all MRI’s when you’re over the age of 50. But not everyone with these “abnormalities” has back pain.

In other words, you can have two people of the same age, with equal-looking MRI’s, and one will have pain while the other doesn’t.

How does that happen?

What research has shown over the years is that what shows up in your images rarely correlates with what’s causing your back pain.It’s why so many back surgeries fail – because we are messing with “abnormal” findings that are in fact – quite normal for your age. So if the structures aren’t the problem – then what is?

Most back pain comes from poor movement habits and lifestyle.

Over time, repeated, unbalanced movements will exacerbate or cause irritation to these structures that are considered “findings”. But you can’t fix your back problem by only addressing where the symptoms are.

You have to address the root cause. This is typically some combination of restoring full and free mobility in your spinal joints and balancing out flexibility and strength. When you move correctly – these structures are no longer bothered – and neither is your back.

I know what you’re thinking – this sounds way too simple and perhaps you’ve already tried physical therapy or something similar and it didn’t work. Sadly, not everyone understands – or even agrees – with the concept of mechanical back pain in the way I’ve just explained it.

But trust me, when you find someone who does, you’ll be amazed at how easy it is to fix your own back. You can then keep the pain gone – without ever having to see the inside an operating room.

Back surgery can be costly – both to your bank account and mental well being.

That’s a lot of money to risk when there’s only a 50% chance of the surgery working. There’s an even better chance that your pain will come back. If there’s a complication of any kind, then you’re looking at more surgeries. This is an almost certain loss in quality of life.

It’s worth it to do your due diligence. Find a movement specialist who understands mechanical back pain and can keep you out of the operating room.

If you’re dealing with back pain now and want to learn more…

We will be talking all about this and more in our upcoming Masterclass for Back Pain & Sciatica Sufferers.

The Masterclass is free – and happening on January 24th from 6-7 pm via zoom. Reserve your seat HERE – spaces are limited – and there’s a limited number of spots left.

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How MRI’s Lead Back Pain Sufferers to Unnecessary Procedures

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Have you ever had back pain and wondered…Do I need an MRI to figure it out? One popular questions I get from clients is if they need an MRI when experiencing back pain or sciatica. It’s pretty standard protocol when you go see a doctor – but is it necessary?

In most cases… NO.

About 70-80% of back problems, even sciatica, are considered mechanical in nature and quite normal. That means there isn’t anything “serious” causing your pain.

Serious causes of back pain include things like a tumor, infection, fracture, or severely compromised nerve. Your symptoms will be pretty specific and obvious to a back pain specialist – and will typically require advanced medical intervention. An MRI can be useful in these cases to get more clarity before medical intervention begins. But when your back pain is mechanical in nature, an MRI is more often than not misleading – and may lead to unnecessary procedures or surgery.

If you’ve had back pain for years, it comes and goes, or you’ve had relief in the past from things like physical therapy or chiropractic treatment…

You most likely have mechanical back pain.

The root cause of mechanical back pain can NOT be diagnosed by an MRI. If your back pain falls into the mechanical category, and you get an MRI anyway, you can end up with treatments you don’t need. Over the years, I’ve seen SO many people with mechanical back pain get major medical procedures that were irreversible and made them worse.

Here’s the problem….

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. Everything from bulging discs, arthritis, stenosis, and degenerative discs, which are all considered normal as we age, but are usually NOT the root cause of your back pain.

What typically happens is the MRI finds them, and your back pain gets blamed on them.

But what we know from research is that all those common MRI findings I just mentioned rarely correlate with what’s actually causing your back pain. Research has shown consistently that you can have two people with identical MRI’s showing something like bulging discs and arthritis, but only one of them will be suffering in pain.

That’s how we know the root cause of your back pain is coming from something else!

One notable study was the Lancet series. Three published papers that investigated how MRI findings related to the treatment of back pain. Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian. In fact, he says: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Do you notice that certain positions or movements relieve your back pain? Or you feel better after walking and exercise? Your back pain is likely mechanical in nature. You don’t need an MRI to diagnose you.

Mechanical back pain responds to specialized movement therapy and a selectively progressed exercise protocol. Mechanical back pain does NOT respond well in the long run to injections, procedures, or surgery, which is what you can end up with if you get an MRI and don’t really need one.

I can’t tell you how many people I’ve seen over the years get surgery for a bulging or herniated disc. Only to find that it didn’t help their problem. Or it came back again with a vengeance. After all, once you have surgery mechanical back pain can actually become more difficult to fix. Your tissues and ligaments are now compromised from surgical scarring. No matter how minimally invasive they say your surgery will be.

If you’re confused, I don’t blame you.

CLICK HERE to speak with one of my specialists for free. They will figure out the right treatment plan for you. And at the very least give you some helpful tips moving forward.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or to get in touch, email her at [email protected].

Three Ways You’re Getting Back Pain Treatment Wrong

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If you’re over the age of 40 and reading this, odds are pretty good that you’ve experienced back pain at least once in your life. In fact, four out of five people are impacted by back pain, and for many, it’s a constant back-and-forth year after year. Keep reading to learn three ways you could be getting back pain treatment wrong.

The first thing you need to understand is that back pain is normal. It’s hard to combat the everyday stressors our modern-day lifestyles impose on our spine. We simply weren’t meant to sit for hours each day or be crouched over electronic devices. Rather than have unrealistic expectations about pain-free lifestyles, we should instead be focusing on ways to naturally manage our own back pain.

Now keep in mind, I make a living off helping people recover from debilitating back pain. But that doesn’t mean I want you to suffer. Here are three ways we’re getting back pain treatment wrong.

1. Quick fixes and passive modalities.

Reliance on quick fixes or passive modalities is how most people attempt to treat their back pain. It’s also the number one reason why back pain returns. A passive modality is something that is done to you vs something you actively do on your own. It’s where you walk in somewhere, lie on a table, and receive some kind of treatment. This could be chiropractic care, massage, acupuncture, or even injections and surgery. You have no active role in the process – it’s completely passive.

Now, I’m not saying there is anything wrong with these treatments. They are great for easing symptoms related to back pain – especially tight, spasmatic muscles. (I have back pain myself and get a massage once per month.) But they shouldn’t be used in isolation. They need to be part of a more comprehensive, movement-based approach to addressing back pain at its source. Plus – you’ll find the relief you get from passive modalities is almost always temporary. And when your pain keeps coming back – it’s a sure sign you’re missing something. Don’t get back pain treatment wrong by relying on passive modalities.

2. Letting MRI’s make the decision.

Traditionally, the medical community diagnoses your back pain with images. If you’ve had back pain for a while, and especially if you’ve already tried some physical therapy, doctors will prescribe an MRI to “see what’s going on” inside your spine. The problem is that what shows up in your MRI doesn’t always correlate with what’s causing your back pain. In fact, 60% of the time, what you see on your MRI has nothing to do with the root source of your problem.

For example, your MRI might show a bulging disc in your spine. Well, did you know that bulging discs are normal and occur naturally as you age? You could have two people with the same bulging disc on their MRI and one will have zero back pain.

Why? Because the root cause of back pain is more complicated than your anatomy. Evidence from research tells us that 70-80% of all back pain is primarily caused by restrictions in your mobility – which is influenced by your habits and the way you move – not by what’s going on structurally in your spine.

So if your doctor lets your MRI make the decision, and recommends surgery to cut out a bulging disc that isn’t even the source of your real back problem, you’ve not only wasted a surgery, but wasted even more time not addressing the real cause of your pain. Letting MRI’s dictate your treatment plan is one of the most overlooked ways we’re getting back pain treatment wrong.

3. The wrong exercises.

One of the biggest problems I see when it comes to treating back pain is non-specific, non-prescriptive, generalized exercises that are designed to make you strong and perhaps even target your core – but it’s before the real problem gets addressed.

Almost 90% of the time, back pain is due to immobility in your spinal joints (vertebrae) that causes irritation of surrounding structures in your spine – such as discs, nerves and ligaments. What we know to be true is that these mobility restrictions can be freed up with very specific movements, in very specific directions, using a very specific frequency during the day.

Once the restriction in your spine is free and you’re moving normally, you can do any exercise of your choosing. It’s at this point that strengthening your core, for example, is beneficial. Because a strong core helps prevent future back pain episodes (but it doesn’t cure a current back pain episode).

To figure out which specific move you need to address your back pain will require help from an expert. But the good news is once you know what movement gets rid of your back pain, you can use it time and again to manage it on your own. But generalized exercises, when done too soon, is another big way we’re getting back pain treatment wrong.

If you’ve been suffering from back pain longer than you should, I hope this information helps you figure out where you might have been steered wrong.

It’s worth getting help from a back pain specialist who emphasizes corrective, prescriptive movement as a means to recovery – vs quick fixes, MRI’s, and generalized exercises.

Want help from one of our specialists? Request a Free Discovery Call HERE to see if you’re a good fit for what we do.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her guide to back pain CLICK HERE or visit her website at cjphysicaltherapy.com.

Are your Back MRI results reliable? Research says otherwise.

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Are your Back MRI results reliable? Research says otherwise.

Whenever pain flares up – one of the most popular questions and concerns I get from clients is whether or not they need an MRI. When you have persistent pain that won’t go away, or shooting pain or numbness down your arm or leg, it’s scary. It makes sense to get a look inside with an MRI, right?

Not necessarily.

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. But what we now know from research is that all those findings on an MRI don’t always correlate with what’s actually causing your pain.

One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain. Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

Let me explain.

When it comes to back problems – or joint problems in general – what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature.

That means your pain has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – which coincidentally is also the time that things like disc degeneration and other age-related changes show up on an MRI.

What it’s important to understand is that disc degeneration, arthritis, and bulging discs are ALL a normal part of aging, but they often get blamed for problems they don’t actually cause. In other words, the source of your pain is often a movement dysfunction learned and repeated over time that is irritating you – not the age-related changes themselves. The best way to figure out if your problem is movement-related vs structure-related is… well… with a movement assessment… NOT an MRI.

So how does movement testing work and why is it more reliable than an MRI? 

This is a great question and not one that is easily explained… but I’m going to try!

When your back, neck or joint pain is mechanical in nature – one of the most important things to look at and pay attention to is how your pain behaves. Not necessarily where it’s located. With pain – the most important thing to determine is how it reacts against certain triggers and with different activities.

Does your pain come and go? Do you have good days and bad days? Can you change positions and influence your pain?

When your pain is variable, it’s the most reliable sign that your pain is “mechanical” in nature. It also means you don’t need surgery or any kind of procedure to fix it. In fact, a procedure or surgery could leave you feeling worse off than before. Let’s say you “cut out” the structure – or inject it to make it numb – your movement problem hasn’t gone away and it’s only a matter of time before it starts aggravating something else.

Take home point… MRI’s are a super powerful and amazing diagnostic tool – but their results when it comes to diagnosing neck, back, or joint pain MUST be taken with a grain of salt – and should absolutely be coupled with an expert mechanical joint evaluation before you decide on a treatment plan.

Because if you are dealing with chronic, long-standing aches and pains that have come and gone over the years – or have recently gotten worse – there is a 70-80% chance that it is a mechanical problem finally catching up to you and not a structural problem.

Figure out the root source of your neck, back, or joint pain by seeing a movement expert who specializes in mechanical pain FIRST. Because when you automatically assume that you need an MRI first, and you base your whole treatment plan off of those results – you can end up down a rabbit hole of unnecessary medical procedures or surgery that ultimately won’t give you the long-term relief you’re looking for.

 

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.

 

 

MRI

How MRI’s Lead Back Pain Sufferers Toward Unnecessary Procedures

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One of the most popular questions and concerns I hear from clients at our specialized physical therapy practice in Portsmouth, NH is whether or not they need an MRI when they are experiencing back pain or sciatica. It’s pretty standard protocol, but is it necessary? In most cases, no.

About 70 to 80% of back problems, even sciatica, are considered mechanical in nature and quite normal.

That means there isn’t anything “serious” causing your pain. Serious causes of back pain include things like a tumor, infection, fracture, or severely compromised nerve. Your symptoms will be pretty specific and obvious to a back pain specialist and will typically require advanced medical intervention.

An MRI can be useful in these cases to get more clarity before medical intervention begins.

But when your back pain is mechanical in nature, an MRI is more often than not misleading and may lead to unnecessary procedures or surgery.

If you’ve had back pain for years, it comes and goes, or you’ve had relief in the past from things like physical therapy or chiropractic treatment, you most likely have mechanical back pain. The root cause of mechanical back pain cannot be diagnosed by an MRI.

And if your back pain falls into the mechanical category, and you get an MRI anyway, you can end up with treatments you don’t need. Over the years, I’ve seen so many Portsmouth physical therapy patients with mechanical back pain get major medical procedures that were irreversible and made them worse.

Here’s the problem.

MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. Everything from bulging discs, arthritis, stenosis, and degenerative discs, which are all considered normal as we age, but are usually not the root cause of your back pain. What typically happens is the MRI finds them, and your back pain gets blamed on them. But what we know from research is that all those common MRI findings I just mentioned rarely correlate with what’s actually causing your back pain.

Research has shown consistently that you can have two people with identical MRI’s showing something like bulging discs and arthritis, but only one of them will be suffering in pain. That’s how we know the root cause of your back pain is coming from something else.

One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain.

Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”

If you notice that certain positions or movements relieve your back pain, or you feel better after walking and exercise, your back pain is likely mechanical in nature, and you don’t need an MRI to diagnose you. Mechanical back pain responds to specialized movement therapy and a selectively progressed exercise protocol. Mechanical back pain does not respond well in the long run to injections, procedures, or surgery, which is what you can end up with if you get an MRI and don’t really need one.

I can’t tell you how many people I’ve seen over the years get surgery for a bulging or herniated disc only to find that it didn’t help their problem, or it came back again with a vengeance.

And once you have surgery, mechanical back pain can actually become more difficult to fix because your tissues and ligaments are now compromised from surgical scarring, no matter how minimally invasive they say your surgery will be.

You can sign up for a FREE 30 minute Discovery Session with one of our specialist physical therapists in Portsmouth, NH right here.

Is Rest or Movement best for Back Pain

Movement is medicine (when prescribed properly)

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I have a confession to make. A few months ago I hurt my own back.

Yes, you read that correctly, the back pain expert injured her own back! I preach this ALL the time to my clients, but one of the reasons I’m so passionate about helping people with back problems is because the treatment is not cookie-cutter. But once we find what works for you, physical therapy is so effective and rewarding.

In my case, I was able to use very specific movements to get rid of my back pain, and then start focusing on strengthening exercises to keep it gone. Don’t get me wrong, there were moments when I wanted to call my doctor and ask him for pain pills, and even the idea of an injection crossed my mind once or twice. But because I keep up with the research, I know that pills and injections really don’t work well for long-term results. Aside from the many potential complications and side effects, quick-fix treatments tend to mask your pain and keep you from doing the real work that is necessary to keep the problem from recurring in the future.

At CJPT & Pilates, long-term solutions are the only thing we are interested in. We believe that movement is medicine.

For all musculoskeletal injuries, including back pain, the research shows that movement and exercise really is the best course of treatment in about 80% of all cases. OK, I know what you’re thinking. If it were that easy, why can’t you just go to the gym, to yoga, or follow an exercise video at home to get rid of your own back or knee pain?

It’s because although movement IS medicine, it only works when prescribed for you properly.

Let me explain.

I’m working with a gentleman right now who’s had back pain for over a year. It started after a car accident. He’s tried regular physical therapy, chiropractic, steroid injections and radiofrequency ablation. None of it worked. He feels good when he exercises and moves around, but the pain always comes back.

When he came to see us, the really interesting thing I noticed about his back was when he put himself in certain positions, he would stand up and literally be crooked. His spine would shift to one side, and become very painful and stiff. In the PT-world we call this a lateral shift, and it’s a sign that indicates he likely has a bulging disc. The great thing about a bulging disc is that they tend to respond very well to corrective movements. Once we know what movement “fixes” you, we can prescribe it to you. This gentleman can now make himself straight and get rid of his back pain in under a minute. Of course the goal is to get him to the point where he no longer needs this corrective movement, but for now, it quite literally is his medicine.

I think the reason more people don’t use this approach is because it requires a little bit of work, and you don’t often see the results immediately. When you get an injection, or even take a pill, the pain is gone in a few hours and it will often stay gone for a period of time without you really needing to do much. With movement, you have to stick with it and do it correctly for it to work. And although you can get an immediate reduction in pain from the correctly prescribed movement, it takes several weeks for it to start to stick and produce long-term relief.

But here’s the best part about using movement as medicine — it’s natural, there are no harmful side-effects, and you can do it completely on your own.

If you’ve been suffering in pain for awhile and tired of using pills or quick fixes to manage your pain, sign up for a FREE Discovery Session with us to find out if movement can be your medicine instead! You can also check out our free back pain guide right here.