Class is in session. You're listening to squat University by dr. Aaron horse Shake. Now. Let's start the show according to Trenton is manic depression settled and flipping in the fantasy. Hey, what's up podcasters? Thank you so much for checking out Today Show. This is episode 68 of the squat University podcast the goal with each and every one of these shows is to bring you as much value pad content help you move better in the gym and in life decrease your body's aches and pains and help you reach your true athletic potential.Now have you ever heard the expression a picture is worth a thousand words. It means the meaning or idea behind something can be summed up better in a single image than a lengthy description. Now the phrase itself should not have any place in the diagnosis of back pain. However, the way in which our current Medical Society works as far as diagnosing pain is often used with this phrase and we'll talk about that today. Tell me if this story sounds Familiar to you you're lifting at the gym one day trying to go heavy and all of a sudden have this back injury something just feels like it pops. You're hung up with back pain for a couple days sometimes even weeks. So what do you do you decide to go to the doctor. Now first off usually takes a little bit of time to get it into the doctor. Usually don't just go straight to the doctor unless you have a great relationship with one or you go to the emergency room for most of us. We're not going to the emergency room with just back pain things start hurting me call up a doctor you make an appointment. Takes a little bit you get in finally see a doctor after waiting for like an hour in the weight room. They look at you. They ask you a couple questions. They don't even touch you and then you go. All right. Well, let's order an MRI and see what you find. So then you have to wait a little bit to finally get your MRI scheduled with first off is not cheap. Then you get your MRI and you have to finally reschedule with the doctor so that you can find out what the MRIs basically showed. So you meet with them a couple weeks later and he goes As well after reviewing your scans, we found that you have a bulging disc. Sound familiar. This happens all the time doctors often today diagnosed back pain simply by looking at an expensive picture of your spine, which essentially is what an MRI is now if you had like a car accident or something else, I was very traumatic injury like a large fault. Obviously, it makes sense that we're looking for huge fractures or things like that with an MRI. So going straight to that can be very helpful at that time, but for the common back injury, especially Lifting we cannot only look at an expensive picture of your spine and think that's the best way to diagnose injury you see many medical practitioners today commonly seek out these abnormal findings like a bulging disc on an MRI and interpret them to be recent developments presuming that these specific tissues are the source of a person's pain. Basically if they see something that looks off on the scan like an MRI. They assumed it to be the exact anatomical cause of your newly developed paint. Now the presumption that these abnormalities on Imaging can be directly linked to the cause of pain is actually flawed for a couple reasons first results on Imaging actually have very poor correlation to the symptoms of pain the MRI cannot show if the damage is a new wound or an old scar pathology does not drive. Mention the fourth reason the MRI only shows Anatomy. It does not show function. So let's dive into each one of those presumptions in why those are incorrect and why the MRI is not the only way that we should go about diagnosing back pain. Now, what if I told you that finding a bulging disc is actually one of the easiest to catch abnormalities with an MRI of the spine. It's true. In fact many people are walking around today with the disc bulge who have absolutely Zero back pain. How can that be? Well, if you actually look at the research, there's some that shows that it is estimated that almost a third of healthy pain-free 20 year olds currently have a disc bulge in their spine in this number of disc bulges actually increases 10% every decade meaning every 40 year-old up out there half of them likely has a disc bulge in his yet not having any back pain at all. I'm 32 years. Old I probably have a couple disc bulges. If you were to take an MRI my spine another research article that has been very eye-opening in 2006 a group of researchers collected MRI scans of 200 individuals without any history of back pain now during the study those who developed severe back pain with in the months following that original MRI had new MRIs taken and the results were compared with the previously taken scans. Now here's what surprising 84% of those who developed back pain during that time had absolutely zero difference in their spine scans from the original one. Some people even had improved markers compared to their first demo right now. Clearly This research is showing that just because an abnormal finding is picked up on an MRI. It does not necessarily mean it is the root cause of your pain now when you see a bulging Disc on an MRI there is no way a radiologist can determine if it is due to a recent event, which we would call like a wound or if it's basically a 20 year old wound a scar. Basically. This is because disc bulges can heal over time and no longer currently generate pain, even though they can still be seen by an MRI. Now what's important to understand is that an injury to the spine is different than an injury to the knee or hip? An injury to the spine sets off this Cascade of events often. For example, when the spine is compressed under load a healthy disc helps distribute that load evenly across the entire vertebral bone. So if you put a big weight on your back your back squatting the disc itself actually acts sort of like an airbag. So when the spine is compressed it sort of pushes the load not to one part of this. Fine, but sort of distributed amongst the entire disk or the entire vertebral spine when a disc bulge occurs load is no longer evenly distributed but instead it's actually shifted to the posterior part of the spine called the facet joints. So wall pain from a disc bulge can eventually burn out in a couple weeks or months the mechanics of how the spine functions is actually instantly changed from there on so the way in which the spine carries low Load after this quad show you had a disc bulge in May and then in October you're starting to develop some paintings because your spine has actually changed the way in which it carries load. It's been affected at that particular segment. Basically from then on out whenever you're loading force on your spine instead of it being evenly distributed on them part of the spine. It's now being shifted a lot of the forces being shifted to the back part of the spine, which is called the facet joints. Therefore if someone at that Time so why not Tobar then goes to get an MRI in their spine. There's no way that the radiologist looking at it can determine if that observed disc bulge that is still there. Is that a new wound that just happened and it's currently generating symptoms or is it just an abnormality that is seen from a past scar. It's scarred over no longer is that disc bulge creating pain in the true source of pain is actually at the facet joints, you can see it actually can become much more difficult to understand as someone that's looking at us. Vine is what I'm seeing is that truly what's generating pain, even if the anatomical structure that was causing pain was identified the knowledge of that problem. It actually does very little for a clinician like a physical therapist chiropractor. Dr. It does very little for us in finding the next possible fix. This is because problems like a disc bulge could be due to a couple different causes. For this reason it would be of no benefit of anyone just to do a simple Google search five best exercises for disc bulge. If you do that, I promise you the results that you're finding are not going to be efficient. Not every single person is going to respond to the same type of treatment based on the anatomy of what is injured in the end. The only person who actually benefits from the knowledge of what exact Anatomy is injured is the surgeon because a surgeon To fix the problem by cutting it out or repairing it. No one else benefits from it. Okay. So here's the next thing to think about in MRI is only a picture of your anatomy in one particular posture. If you've ever had an MRI, I've had a few you're just laying in this machine same thing for the CAT scan same thing as an x-ray your in one particular posture. They take a snapshot. That's what they're looking at. It would be naive to think that a mechanic. It could look at a picture of a race car in know exactly why it seemed to me make like a weird noise when you're shifting from third to fourth gear at 60 miles an hour. Just think about it if you took your car to a mechanic and they're like just just take a picture of the engine. I can figure it out from there be like I have no trust in this mechanic. There's no way in which I could diagnose my car troubles with just looking at a picture. However, our society is very hesitant to do the same thing with our medical doctors. Better attempting to interpret what's going on with our spine just by taking an MRI of it that makes sense in order for a skilled mechanic for a car to truly diagnose a problem with the engine. He's got to take the car for a spent. You're going to say. Hey wait here. I'm going to go take your car for a spin on the look at some things. I'm going to rev the engine up. I'm going to test the capabilities of it. I'm going to slam on the brakes real hard. I'm going to see how things are working the mechanic must establish context for what's eating a problem the same goes for our physical body. We need context through a full physical movement first examination in order to uncover. What is actually triggering pain what movements would loads what postures what is creating pain can just look at a picture. It is only after we go through a full movement diagnosis that we can then turn to Imaging if we want to to look deeper into what specific tissues may be driving or symptoms. Now this is not to say that the MRI results should be completely dismissed because that's not what I'm saying. I'm just saying that the findings the content of an MRI should only be interpretable within the context of a full evaluation for what is actually causing our pain. So here's an example of how we could correctly view the results of an MRI. So let's go back to that prior story that we talked about your lifting all of a sudden you have pain. Pain and blah blah blah you go on to the doctor's office get an MRI the first thing that should happen whenever you go into a practitioner is that they should do some movement testing and screening so sort of determine what is creating pain and what takes it away what feels good. So here's a simple test you can perform to understand of whether or not a disc bulge. Is it truly an active disc bulge? Is it a new wound or is it an old scar now? This is a test that I've learned from. Dr. Or Miguel de we're now back expert I definitely recommend going back. I've had them on the podcast three times go back and listen to the stuff that we've done together in the knowledge that he shares because it's just truly amazing but one of the tests is basically just sitting in a chair and you're going to start in a neutral spine position, which means set up with good posture. You're going to take your hands on the bottom of the chair and you're going to pull up. So basically you're in a try to compress your spine straight down, but keep it in that neutral position. What? What happens did they create pain? Yes, no, next you're going to round your back like crazy Flex it and then do the same thing. So basically you're combining flexion and compression or force and does that create back pain? So yes or no for someone that maybe has a disc bulge that's often going to create some pain. So then let's find out. Alright that creates pain what feels good now if you get up and walk around for 10 minutes, Have less pain or you line your stomach for a few minutes in a slightly extended spinal position. What happens did the pain lesson you see when we move to understanding how the body generates pain, but then also what feels good were able to put more context to the pain that we're having. So after that I may do some other types of tests with someone that comes to me with the situation. So for example, you're having pain with lifting now, Let's say you only have pain with a deadlift or squat but in doing so like a squat you notice that as you get all the way down to the bottom squat your spine is actually flexed a little bit. So you have a little bit of that but wink and that brings out pain, but what if all of a sudden we change your squat pattern just slightly in clinic and I say squat only to a point where your back remains a neutral so don't go all the way down. What happens. Does that decrease your back pain? Do we just change? Or symptoms by changing your movement. So understanding that if we can limit excessive flexion of the back it does that decrease pain. We can also come to the understanding that movement of flexion under load is a current trigger for pain. So this is all giving us more context. If we wanted to add that time. We could then look to an MRI and say with more confidence that the disc bulge that popped up at that certain level is likely inactive just fault. Judge, which of the anatomical cause of pain see when you sit down and you Flex under load with the chair stretch or when you squat all the way down to the bottom and your backgrounds uneven Force distribution at that spinal segments pressurizes the disc in a way that is forcing more to that inner nucleus to seep its way through the outer rings of the disc, which is then triggering paints Dynamic disc bulge without that context through the examination. There's no way. Determine if that disc bulge found on MRI is the exact cause of pain. So you have to have both we cannot just look at an MRI. So where did the story for most of us who go the traditional route of seeing a doctor who doesn't even touch us just talks to us and then gets an MRI where most that turns takes a turn for the worse. Our story is that the only form of evaluation is ordering an MRI the evaluation for someone in back? Pain is the most crucial part of fixing pain because it establishes the foundation from which the entire treatment plan is then based upon and the case for most of us. It's established on this very Rocky assumption that a picture is worth a thousand words. So I hope you guys liked today's podcast and were able to take just a little bit of a better understanding of way that the next time you go to a Her and they asked to only do an MRI and they don't do any other types of testing understand that you're probably not at the best doctor for you. I would highly recommend going to see physical therapist chiropractor medical doctor that treats from a movement perspective who understands how to screen the body properly by not just looking in ordering some expensive Imaging now, if you would like to learn a little bit more on the way in which I recommend screening back pain, All you have to do go online Squad University.com under the blog article tab at the top scroll on down. There's a Blog for free that says how to screen your low back pain just walk through that's a very simple process and it can give you like I said today a little bit better context for what may be triggering your pain. You don't need to have an expert clinician there to tell you what specific and natta me may be injured you have to understand a movement first perspective because here's the deal twould guides been the next couple steps in your rehab understanding disc bulge or fassett impingement or end plate fracture itself in itself does not drive your treatment but understanding necessarily loading tolerance flexion and tolerance extension and toners that gives us just a little bit better understanding for our first steps that we need to take right after that to decrease our pain and then build resiliency with a proper training program that's individualized to your body and Ember there's no one-size-fits-all when it comes to back pain. You have to understand how you were presenting and then how we can then build back on top of that to find your best treatment plan. I hope you guys liked today's quick podcast. If you did, please hit me up at Twitter is quite University and just give me just a little bit of feedback if there's something you want to listen to in the future or any guess that you'd like to have on the show until next week guys. Happy squatting. That's it for today class on squat University by dr. Aaron horse jig for more exclusive content, log on to squat University.com.
In episode 68, Dr. Aaron Horschig breaks down why you shouldn't place your complete trust in MRI results for low back pain. Research has estimated that almost a third of healthy pain free 20-year-olds currently have a disc bulge in their spine! (Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015;36:811-16) This number increases 10% every decade, meaning 45-50% of people between the ages of 40-50 have a disc bulge but with no back pain at all. It is highly likely to have abnormal scary findings on the MRI if you’re above the age of 60 but many of these individuals have no low back pain at all. Can a disc bulge create back pain? Sure. But just because there is one that is picked up on an MRI does NOT necessarily mean it is the root cause of your pain. Check out these referenced articles:    Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69-73  Carragee E, Alamin T, Cheng I, et al. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006; 6(6):624-35   Fukuda K & Kawakami G. Proper use of MR imaging for evaluation of low back pain (radiologist’ view). Semin Musculoskelet Radiol. 2001;5(2):133-6 