Herniated Discs, MRIs, and Low Back Pain: Part 1


"Did you hear about the study of the MRIs and herniated discs?" It was 1995, I was working at St. Mary's Hospital, and one of my fellow massage therapists had news about a surprising piece of research. In those days before the internet it was difficult for us to get information about studies of interest to us massage therapists. A juicy tidbit like this was cause for excitement.

A team of researchers had examined 98 people with no back pain. MRIs revealed that over half of them had at least one herniated disc and almost 40% of them had disc abnormalities of more than one disc. I found this piece of news stunning. Herniated discs were often blamed for low back pain. What this study showed was that half of adults may be walking around with at least one herniated disc . . . but no pain! If any of those individuals developed back pain and an MRI revealed a herniated disc, it would be assumed this would be the cause of the pain. However, since it would be unlikely for a person without pain to have an MRI, it could very well be possible that the herniated disc had existed for years. Clearly, the presence of a herniated disc did not have to correspond with pain.

I thought this news would send shock waves through the orthopedic, physical therapy, and pain management communities. I guess I was pretty naive. It is now 2013, almost 20 years later, and every day people with back pain continue to be told that their pain is due to a herniated disc. What is that all about?

Even in 1994, this study stated that "The presence of disc abnormalities in the lumbar spine of asymptomatic people is well known." Subjects in that particular study ranged in age from 20 to 80 years old. Although the presence of bulges and protrusions increased with age, the study includes an image of a disc protrusion in the lumbar spine of a 21 year old man who had no back pain. Other studies using MRIs, CAT scans, myelograms, and post-mortem examinations had found disc abnormalities in 20 to 60 percent of individuals who did not have back pain. 

Five years before, in 1989, a study examined sixty-seven individuals with no history of back pain and found that 31% of them had disc abnormalities. A follow-up study seven years later found that some of the original subjects had developed back pain but there was no correlation between the presence of a herniated disc and back pain. Some people with herniated discs developed pain, some did not. Some peope without herniated discs developed pain, some did not. The percentages were about equal.

One or two studies are not enough to prove a point, but study after study has shown that there is little to no correspondence between low back pain and herniated discs.

A recent (Mar. 14, 2013) study published in the New England Journal of Medicine has again reinforced what has now been known among pain researchers for at least 20 years: that the presence of a herniated disc is not predictive of low back pain. Two hundred eighty-three patients entering a clinic for low back pain were examined. Some had herniated discs, some did not. After one year, 84% had complete or near complete disappearance of their pain. Reexamination with MRI found that disc herniations were still present and were just as likely to be found in those with pain as in those with no pain. The presence of herniated discs seemed to have no correspondence with whether people had pain, their degree of pain, or whether they got out of pain. 

Why are people still being told that their back pain is due to the presence of a herniated disc when it has been clearly shown, over and over, that there is no correlation? 

And why are MRIs still routine when it been shown that not only are they not necessary, they may actually interfere with resolving back pain? 

We'll continue to look at this and a few other questions in our next article. 

Submitted byGuest (not verified)on Sun, 09/15/2013 - 10:30am

I have heard for years about these studies regarding herniated disks. But my question has always been, if it is not a herniated disk that is causing the pain, WHAT is? Or could it be that SOMETIMES it IS a herniated disk that is causing the pain? AND, I have had clients who had surgery because of herniated disks and their pain was gone after surgery, and I have trouble believing that was all because of a placebo response. So the question still remains, what DOES cause some cases of severe and persistent low back pain?

 Sarno was an early pioneer who realized that there was more than just a "issue with the tissue" with back pain. He was definitely heading in the right direction. At the time, it was conjecture and there was little evidence to back him up, but we've learned a lot since then. 

I think he wrote more than one book. I read his first book long ago and it seems he attributed lot of back pain to repressed anger. While I'm sure this is a factor for some people, I think there can be many psycho-social factors and not all of it could be blamed on repressed anger. I don't know if he later modified that stance. However, his insight into the psycho-social factors that influence pain were ahead of his time, and his books have helped many people manage their pain when other means did not. Thanks for bringing him up.

I had a severe chronic back pain the day I read his book many years ago. I took his advice, and the pain was gone in the same day. I started re-programing my mind since then (I meditated on it); the back pain did try to come back; but I could use the mind trick to keep it away.
In traditional Chinese Medicine; the best cure comes from the mind. It proves to be true in my case. Thanks!

Another great approach to eliminating back pain is, "Treat our Own Back", Robin McKensie. He shows very simply how to correct many of the causes of back pain. He also shows an exercise to improve the strength of back muscles. I would also add that it is necessary to also improve the strength of abdominal muscles to maintain a balanced support.