Who among us has not heard a family member, friend or acquaintance complaining about a hernia?
In my osteopathic career, I have had the opportunity to assist and help many people in the throes of excruciating pain, often concomitant with a hernial condition.
But is it really like that?
The results of a 2015 systematic review highlight how even subjects without back pain have alterations of the disc and the lumbar spine!
That's right! It may seem absurd to you but it is possible to have back pain without having alterations highlighted with instrumental tests. Very often there are patients who have undergone an MRI because they had back pain, but the MRI did not reveal anything particular, that is, clinically relevant. There is even almost a disappointment because they were sure they would find the proverbial "hernia" that their uncle also says he has and which the orthopedist said was the cause of his problem. And instead… nothing!
If there are no hernias or other particular conditions, the back pain depends on something else.
In these cases, lower back pain may be the manifestation of a disequilibrium more global and theorthopedic diagnostic clinical classification before, joined to osteopathic treatment then, they are very effective in helping these patients, identifying the anatomical areas "distant" from the back which still influence the health of the lumbar. We cannot forget that of all the causes of back pain, lack of physical activity seems to be one of the most frequent and impactful!
The 2015 study published in American Journal of Neuroradiology reports how the authors collected 33 different studies that performed MRI on subjects WITHOUT backache.
“In healthy subjects, who do not have back pain, in what condition is their spine and in particular the lumbar intervertebral discs?”.
In total 3110 subjects were divided into various decades from twenty-year-olds to eighty-year-olds. It's incredible how high the percentage of young people WITHOUT back pain but WITH disc alterations is! Amazingly, in the case of protrusion and fissuring of the annulus, there is little difference between 20-year-olds and 80-year-olds (respectively 29%–43% e 19%–29%).
How can we interpret these results?
Given that many asymptomatic subjects present alterations, the authors state that the alterations are part of the normal aging process rather than the manifestation of a pathological process that necessarily requires intervention. Shareable, but not totally as we need to do our utmost to also improve the quality of the normal aging process.
The arduous task of us clinicians is to educate the patient, explaining to him how the presence of a hernia is not necessarily the explanation for his back pain. We're in too Health Hub, since we had the opportunity to discuss and share this article, we have patient education at heart and we tend to do a very simple thing: we turn the computer towards the patients in front of us and show this data, explaining the table in detail. Patients usually really appreciate the clinician who "invests" time in explaining their condition. Once the evaluation phase is completed, it is essential to agree on a suitable therapeutic path together. Replace thinking with practice.
#STAYHEALTHY #STAYHAPPY
W. Brinjikji,a P.H. et al. “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations”. AJNR Am J Neuroradiol. 2015 Apr; 36(4): 811–816. doi: 10.3174/ajnr.A4173 PMCID: PMC4464797 NIHMSID: NIHMS696022 PMID: 25430861
