19/02/2020
𝐁𝐚𝐜𝐤 𝐏𝐚𝐢𝐧
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📌One of the issues I get the most questions on is low back pain, especially disc herniations. While there is a lot that goes into this question, two things I usually mention are that disc herniations are common in much of the asymptomatic population and that they can heal with time and conservative treatment.
🔎The following is a case report that documents the resolution of a lumbar herniation without surgery and demonstrates that pain can return when the apparent disc ‘injury’ is no longer present. Pain is complex!
📕The MRIs shown here are from a 32 year old male who presented to the hospital with severe back pain in two different occasions. On October 2012, the patient did not have any neurological deficits, so physical therapy and a short course of oral steroids were ordered and his pain resolved.
📘In October 2013, another MRI was ordered when the same patient once again entered the hospital with severe back pain. This time around, his disc herniation was no longer visible.
⁉️What does this teach us?
1. Pain does not necessarily indicate tissue damage. In both situations documented above, the patient had low back pain. At the time of the first episode, a potential tissue insult could be identified. This was not true at the time of the second episode of back pain.
2. Disc herniations can resolve with conservative care and time. The details of this individual’s rehab were not given, but it is important to know that relatively simple programs that include movements like walking, general low back mobility drills and low load resistance training exercises help the majority of people. A healthy dose of patience (up to 4-6 months) is important too.
References:
📚Zhong M, et al. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician J. 2017.
📚Chiu C-C, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015.
📚 Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015.