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Imaging and ‘big scary things’

Fit to Farm: The things most often seen through imaging of the spine are not always the cause of symptoms

Regardless of how back pain started, many sufferers go on to be referred for medical imaging such as X-rays, MRIs, and CT scans. As a practising rehabilitation specialist I see imaging as both a blessing and curse, in the majority of cases I see.

Research has shown that the big scary things we so often see through imaging in our spines are not always, if rarely, cause for the symptoms we experience.

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Adults over 40 can expect to show degeneration in their lower spines. Arthritis, disc degeneration and protrusions, and even some disc herniations have been seen via imaging in adults who don’t have any real-life symptoms or pain.

Often the fear and apprehension that arrive from seeing a big scary thing on an imaging report actually cause more tension and alarm in our systems, in turn, exacerbating symptoms.

In the study of pain science, it’s well documented that many degenerative conditions of the spine are not actually what causes the pain itself. The pain itself is caused by patterns in the nervous system, and once safety is re-established as a perception and pattern for the nervous system the symptoms dissipate — whether or not the imaging report finds any change structurally.

More pain science research suggests that the expectation of pain itself is a self-fulfilling prophecy.

A client’s reaction to imaging is often what guides my recommendation of imaging. If they are the type who will find resolution in knowing what’s going on, imaging perhaps will be helpful to them to progress forwards with functional rehab. I never discourage imaging, however, if it’s sought out by a client or their referring physician.

A fairly common cause of back pain is disc injuries and degeneration. There are many schools of thought on disc-related pain, and information is being rewritten constantly.

Over the last number of years the research and recommended practice for various big scary structural changes in the lower spine have moved away from surgery with bed rest being the preferred option. This doesn’t mean that surgery isn’t ever helpful, it simply suggests that the repair of the structure isn’t necessarily the decider of pain or no pain.

When it comes to pain, we must review our relationship with it. Pain is not a bad thing to be avoided. It is simply a communication method from our bodies and more often than not when we spend some time working with it and reframing our relationship to it, it begins to become less aggressive in its communication method.

Active therapies that include movement, education and modern pain modulation coaching are in, passive therapies are out. This doesn’t mean that seeking relief in the forms of massage, electrical modalities, or other hands-on practices is a bad thing. It simply suggests that active therapy is what truly helps us reframe and reset our nervous system’s expectation of pain.

About the author


Kathlyn Hossack runs a clinical practice, Integrative Movement in Winnipeg, Manitoba and consults clients throughout Alberta on a regular basis. For questions or consultations email her at [email protected].

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