So if what I am seeing on my x-ray or MRI isn’t causing my pain, what is?
To answer this we have to answer the question what is pain. Pain is a signal or an alarm, that’s it. It comes in many different forms and much like your car alarm can go off when there is no REAL threat, our bodies can sound the alarm when there is no damage or threat as well.
Most people think of pain as a signal that we are doing damage to our bodies, but this is not the only trigger for pain. For example, pain can come from weak and deconditioned tissues not able to cope with our day to day requirements, excessive tension in muscles and fascia (connective tissue) where repetitive movement creates stress and tissue inflammation, and of course from acute injuries such as contusions (bruises), sprain/strains from sports-injuries, and tissue loading problems such as lifting injuries in the low back. The commonality between all of these examples? Most, if not all of these types of injuries will likely not be specifically identified on imagining other than the consequential inflammation associated with the injury.
As previously mentioned, emotional pain associated with depression/stress/anxiety can cause physical pain and has been shown to cause both chronic (long term) and acute inflammation (our body’s reaction to injury). Even FEAR of pain can even cause physical pain! The very act of thinking “I can’t deadlift anymore because I have degenerative disc disease and it is always going to hurt” can actually bring on pain before you even perform the lift!
To summarize by example, the majority of x-ray findings you will often see from longstanding wear and tear in the spine doesn’t mean you have to live with low back pain for life! In fact, more often than not the pain generating structures will have nothing to do with what’s seen in your diagnostic imaging. It’s possible your degenerative disc disease isn’t causing your pain, but rather the muscular imbalance of your core stabilizers or the longstanding lack of hip mobility from fear of using your spine is! The overall message here is that I encourage you to not let imaging findings be the only piece of information that tells you what your underlying problem is. Work with a healthcare professional that can perform a thorough history and physical examination, and if necessary, use diagnostic imaging in conjunction to the clinical findings to properly advise you on the problem and the appropriate solution. As per my favourite quote by Dr. McGill, make sure to focus on the whole picture and not a just snapshot of the wrinkles on your face.