My mum (73yrs) has had low back pain and sciatica down her right leg for several years now. I’ve been trying to persuade her that her back probably isn’t as fragile as she’s been told and that exercise, ideally resistance training, could help her. I haven’t had much luck yet (is it me or do folks get more stubborn as they get older!?!), but I’m persisting.
I asked a question here a while ago and Austin pointed me towards his pain articles and Lorimer Moseley’s lectures, which I found fascinating. They’ve really changed my outlook on pain and have helped me a lot when I’ve had various ‘tweaks’ while training. I’m really interested in whether my mum’s pain is encapsulated by the biopsychosocial model or if there could be something more concerning causing it.
She recently showed me a report of an MRI scan that she had done a couple of years ago. It’s got various medical terms, which I’ve googled, but I’m not sure of how serious they are. I’m worried about suggesting she tries exercising/training if she genuinely has some structural/neurological problems that could be made worse. So, I was hoping that you could give me your opinion. I appreciate that there might not be enough info here for you to give a definitive answer, but any input would be appreciated.
So, to summarise what the MRI shows (as interpreted by the radiologist): 1. Mild kyphotic deformity of the upper lumbar spine.
2. Gross degenerative changes in the intervertebral disc and facet joints at multiple levels in lower thoracic and lumbar spine.
3. Mild grade retrolithesis of L2 and L3 vertibral body.
4. Radial bulge and small disc protrusion at L4 and L5, however without thecal sac or neural compression.
5. Small extruded fragment of disc in the left sided lateral recess at this level, indenting on the traversing left L5 nerve root (however clinical symptoms are in right leg).
6. Facet joint hypertrophy at multiple levels in the lower lumbar spine causing mild bony spinal stenosis, the large right sided radial bulge of the disc at L2/L3 may be slightly impinging on the exiting right L2 nerve root.
7. Lower spinal cord and conus medullaris appear normal. Dr Moseley points out that an MRI of just about anyone my mum’s age would show all sorts of disc degeneration and bulging, without associated pain, so am I right in thinking that points 2, 4 and 5 aren’t concerning? It’s more points 3 and 6 that I’m unsure about.
Many thanks!
P.S. I think that Dr Moseley would make for a great podcast guest!
I really wish I could get this concept across better, since it seems people are thinking I’m just saying all pain is just psychological:
ALL pain is “encapsulated” by the biopsychosocial model. All of it. Every time. No exceptions.
The “more concerning” contributors to pain you describe are precisely the things that fall under the bio- part of this model, but the pain experienced by the patient is also modulated by the psychosocial context. I could hold your arm out in front of you and saw it off, and whatever pain you felt would be fully encapsulated by the model.
Kyphosis, i.e. “hunchback”.
Typical, unsurprising age-related changes.
One vertebra is mildly shifted back relative to the other.
Disc protrusion that isn’t touching any nerves or spinal cord structures.
Disk extrusion touching the left L5 nerve root – (as you said, her symptoms are on the other side, AND the majority of disk extrusions heal on their own in a few months. Since this MRI is several years old, there’s a good chance this thing is gone now).
Facet joint hypertrophy is more age-related change (the kind of stuff people tend to call “arthritis”). Mild spinal stenosis is not particularly relevant, and is a bit subjective by a radiologist’s interpretation. By your history, there are no apparent symptoms correlating with a right sided L2 radiculopathy.
Great! I think I’m understanding it more fully now. I had overemphasized the ‘psycho-’ part of the model and in my mind thought pain was either biopsychosocial or something else (something physically wrong). Now I see that it all falls under the biopsychosocial model. Thanks for your patience in explaining that to me.
It’s good to hear that you don’t think there’s anything too concerning in her MRI. I will continue along the path of spreading the BPS model gospel, and hopefully I can help her out.
Many thanks again for your help, and congrats on your recent graduation.