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Low Back Pain and Image Findings

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  • Low Back Pain and Image Findings

    My dad is 60yrs old and has been dealing with some low back pain for ~6 months. One of his legs also sometimes feels painful but I think that has mostly resolved. There was no acute start to the pain, though he associates it with some rack pulls he did the day before the pain started. This coincided with covid and so he stopped training. I've now got him training a little at home.

    About a month ago he went and got some sorta imaging on his low back, because his doc recommended it and told him there might be a disc injury causing the pain. When I heard he was going to do this I warned him that it is very normal to find bulging or herniated discs in pain free individuals and given his age it is very likely there would be something, but it probably wouldn't inform treatment. Sure enough they found something. It was a disc herniation or bulge, I don't even recall what exactly. When presented with these findings my dad asked if this was definitely the cause of his pain given the high prevalence of these findings in pain free individuals. He was told that while disc herniations and bulges are common in pain free individuals his image findings are so extremely bad that it's clear the bulge/herniation is the cause of his pain. My initial thoughts in response to hearing what the doc told him was: what a nocebo. Different docs see different things in the same image, so it may not really be anything extreme (what guidelines are being used to determine that it's an extremely bad disc finding?). If there is a disc issue it will probably resolve without surgery.

    He got some sorta shot in his low back, that may have given him a little relief for one day. His doc told him not to DL or Squat and at least implied that he shouldn't use his low back.

    Is it plausible that a disc image finding could be so extreme that it's clearly causative of pain? If so, would that inform treatment at all?

  • #2
    Is it plausible that a disc image finding could be so extreme that it's clearly causative of pain? If so, would that inform treatment at all?
    No, any imaging finding still needs to be correlated with the patient history and examination findings.

    I would recommend a consult with our rehab team, if he's open to it, in order to get a better interpretation of these findings and plan for moving forward.
    IG / YT


    • #3
      Thank you for the quick reply,

      I actually recommended he get a consult with the BBM rehab team when he first got the imaging results back. He's resistant to getting a consult, but I could keep trying. Based on the info I gave you, do you think it's a bad idea for me to continue bringing him along the approach in your article Pain in Training: What Do (Starting 2 weeks ago I've got him doing a low dose of BW high box squats, and I've made a tiny bit of progress in building his sense of self efficacy and shifting his focus to building tolerance rather than finding a magic exercise)? Or is it just insufficient info, requiring a consult to have any confidence in the potential risk/reward of gradual reintroduction of exercise?


      • #4
        Given the history you have laid forth at this point your plan sounds good. We would be happy to talk to him if he would like. More than anything, what you are currently doing by encouraging him to continue to be active and helping him workout is going to be one of the most beneficial things you can provide.


        • 4l3x
          4l3x commented
          Editing a comment
          that's good to hear, thank you for replying.