Dr Liam McCambridge
BSc (Clin Sci), MHSc (Osteo)
Happy snaps of our insides can reveal a lot, helping doctors to diagnose disease and provide a management pathway for patients. From injuries like Antonio Winterstein’s broken arm and Matt Scott’s ACL tear (the Cowboys really are the walking wounded at the moment!) to diagnosing heart defects, cancer and stroke, medical imaging is truly a scientific marvel! It is a useful tool for many health professionals as a starting point to getting you back to health. However, like everything in life, medical scans have their place, especially when it comes to back pain.
“I Have a Disc Bulge”
This is a line I hear from patients every day. They learn this as the result of their CT and MRI scans and they start to think they will need constant treatment just to keep them moving, if not surgery to heal them completely. This idea often comes from the 24/7 availability of WebMD and Dr Google (which also leads to some other ‘interesting’ results!)
Let’s face it, we all know someone (or are someone) who has done this! Image courtesy of someecards.com
Now, I am all for my patients wanting to get a grasp on what their back pain might be and becoming educated on their condition, and Google can be a great source… as long as a health professional guides you on where to look. A Google search through such a Donald Trump-sized amount of information is like doing a puzzle without knowing how the final picture is meant to look. You can research your symptoms or what to do about your disc bulge, but without advice, you will never have the full picture. You know how many pieces the puzzle has – like you know you have a disc bulge – but where do you go from there? It’s frustrating, and can often leaving you feeling like there is no end in sight.
“So… will I need surgery or can you pop it back in?”
One does not simply ‘pop a disc back in’. Image courtesy of quickmeme.com
The short answer is “probably not” and “no” (no one can pop your disc back in… it’s not a thing), but this is the wrong question to be asking anyway. The important question is “does the disc bulge cause my pain?” It sounds like a strange thing to say, but often the pain you feel is more to do with muscle weakness, tightness and local inflammation than the actual diagnosis on a scan. 30% of 20 year-olds have disc bulges, and 37% of 20 year-olds with no pain have disc degeneration. That’s more than 1 in 3, and there is no way that 1 in 3 people in their 20’s should be having invasive surgery to repair a disc. Just because you’re in pain, it doesn’t mean it’s your disc, and just because you’re pain-free, it doesn’t mean you don’t have a disc bulge. Pain is rarely a good indicator of how bad an injury is, but how that pain changes with treatment will help us know the answer to the next question…
To scan, or not to scan – That is the question (Shakespeare… kind of)
Around 80% of people in Australia will suffer from back pain at some stage, but 80% of all people definitely do not need a scan. For the majority of people, their condition, disc bulge or otherwise, can be diagnosed with an in-room assessment, no radiation dose required. From this point, the important thing is progress. While it’s great to know what’s wrong with you, knowing that doesn’t really help the situation unless you act on it. So, when is a scan needed? Realistically, only if the injury is not resolving as expected or to rule out anything nasty, such as a fracture, especially if there is a history of trauma. As osteopaths, we aim to get you back to health through treatment, exercise and home advice, helping you return to the things you love. If a scan is required, and it shows something that we cannot help with, osteopaths are trained to refer you to another health professional to help get you on the path to better health.
Osteopaths would definitely refer this case elsewhere! Image courtesy of simpsons.wikia.com
X-Ray, CT and MRI scans are a great way to get answers when the clinical picture is unclear, or when it seems that something sinister may be brewing beneath our fleshy exterior. But, in the end, these scans are rarely required, with most injuries treatable without further investigation. While it’s lovely to know the answer to life, the universe and everything, knowing the right question to ask is just as important. So, I pose that the answer should not be “disc bulge”, with the question being “what’s wrong with me?” The question should be “how do I make this better?” Your osteopath may be able to guide you on the path to the right answer.
Dr Liam McCambridge is a full-time Osteopath at Townsville Osteopathy, who knows that MRI results can be scary. Having been told at age 20 he had 2 disc bulges from a car accident, he gratefully avoided surgery with some careful, guided treatment and rehabilitation from his osteopath… and all by asking the right question. You can find out more about Townsville Osteopathy on our site, and follow Townsville Osteopathy on Facebook and Instagram.