I use MRI in lower back pain 🤭
I also get asked frequently how I manage the scan follow up consults & handle patient Qs
So here is a mini-thread which gives a little comms synopsis - some may nod sagely, others may roll their eyes - that’s cool - no right or wrong.
I also get asked frequently how I manage the scan follow up consults & handle patient Qs
So here is a mini-thread which gives a little comms synopsis - some may nod sagely, others may roll their eyes - that’s cool - no right or wrong.
1. Normal scan-
“This is great news- there is no evidence of damage or injury …you don’t have a ‘bad back’ - it is just unhappy at the moment. There’s no reason why we shouldn’t be able to help you get back to the sport you love & crack on with work”
“So why am i in pain…?”
“This is great news- there is no evidence of damage or injury …you don’t have a ‘bad back’ - it is just unhappy at the moment. There’s no reason why we shouldn’t be able to help you get back to the sport you love & crack on with work”
“So why am i in pain…?”
2. “An MRI isn’t a ‘pain scan’ - your pain can come other structures - very often the muscle or it’s lining (fascia). We can’t see muscle pain on a scan. Joints & discs can cause discomfort / stiffness without being damaged. They are just irritable”
3. “A normal scan demonstrates that your pain over the years has not represented cumulative harm or damage. Pain can become unhelpful over time & disproportionate to what is going on underneath. This should give you confidence to work through discomfort to a degree”
4. ‘Normal age related changes’ (NARC) -
“We anticipated that the MRI would show changes that occur in lots of pain-free people fot & active in the general population. Think of them as ‘wrinkles’ - they don’t look great - but they don’t hurt”
“We anticipated that the MRI would show changes that occur in lots of pain-free people fot & active in the general population. Think of them as ‘wrinkles’ - they don’t look great - but they don’t hurt”
5. “When we get to 40, 50% of people have disc bulging or signs of ‘wear’. It’s common & nothing to be concerned about; your back is still stable & strong and with support we can help you move towards getting on with life as normal”
6. Disc herniation-
“The MRI confirms what we discussed in the first appointment - a bulge has likely happened slowly over time - the disc isn’t weak & vulnerable, and hasn’t just ‘slipped’ - it’s just got to point where it is causing mischief & irritating the nerve next to it”
“The MRI confirms what we discussed in the first appointment - a bulge has likely happened slowly over time - the disc isn’t weak & vulnerable, and hasn’t just ‘slipped’ - it’s just got to point where it is causing mischief & irritating the nerve next to it”
7. “Most sciatic flare ups get better after 6 weeks. Don’t be afraid to keep moving- it’s safe! -take meds to help with this. If the pain doesn’t improve, the scan allows us to safely organise an injection to calm the nerve down”
“Does the bulge go away - does it need removing?”
“Does the bulge go away - does it need removing?”
8. “sometimes big bulges shrivel up but that’s not necessary for your pain to go away. The nerve is inflamed & will settle in most cases without removing the disc or it disappearing. The nerve is rarely damaged by the bulge either but we will keep a close on your pain / strength”
9. Modic 1 changes🤭
“Some feel these can suggest the disc is ‘unhappy’ - it might explain the pain that wraps around your hips & into your buttocks… it just means we may need to pare things back a little & build up in a graded fashion. We don’t need to scan your hips”
“Some feel these can suggest the disc is ‘unhappy’ - it might explain the pain that wraps around your hips & into your buttocks… it just means we may need to pare things back a little & build up in a graded fashion. We don’t need to scan your hips”
10. Lumbar stenosis -
“Over time the joints & discs have caused some narrowing of the nerve tunnels, which is why you get aching in the legs when walking & in certain positions such as leaning back. It’s still safe to exercise but we just need to be clever in how we approach it”
“Over time the joints & discs have caused some narrowing of the nerve tunnels, which is why you get aching in the legs when walking & in certain positions such as leaning back. It’s still safe to exercise but we just need to be clever in how we approach it”
11. “Will an injection help?”
“Injections don’t work that well. But it’s been shown that certain exercises & strength work can improve your pain & endurance - the aim is to tailor the exercises to your needs & give you the tools to manage your symptoms on your own”
“Injections don’t work that well. But it’s been shown that certain exercises & strength work can improve your pain & endurance - the aim is to tailor the exercises to your needs & give you the tools to manage your symptoms on your own”
12. Spondylolisthesis -
“I can see how the scan might look a bit scary - but they are surprisingly common & your back is still very stable - I have professional rugby players with these changes & it is absolutely safe for them to play high level contact sport”
“I can see how the scan might look a bit scary - but they are surprisingly common & your back is still very stable - I have professional rugby players with these changes & it is absolutely safe for them to play high level contact sport”
13. Hope this is helpful. Would love to hear how others approach this and communication pearls.
Id strongly recommend listening to @adamdobson123 and @Retlouping podcasts on imaging in back pain & do discs slip - amazing insight podcasts.apple.com/gb/podcast/the…
podcasts.apple.com/gb/podcast/the…
podcasts.apple.com/gb/podcast/the…
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