How Common Are Back Problems?

You might not know what the word "iatrogenic" means, but I'll bet you've experienced it.

If you've ever had lower back pain, gone to the GP who has sent you for a scan and been told that you've got a bulge, or a slipped disc, and so you'd better be really careful, so that's what you've done but now you're really depressed because you're worried about your discs slipping...that's an example of iatrogenesis.

Or if you have gone to see your doctor because of some pain in your shoulder, and the GP has told you it's chronic and sent you to a pain clinic, and the pain clinic has told you that you just need to meditate a bit and think differently but that's just annoyed you and you feel both angry and abandoned. That’s an example of iatrogenesis.

Iatrogenesis is the effect a medical or health professional can have on a person that is detrimental to the patient. Perhaps an more obvious one is an infection you might pick up in hospital...but it doesn't just apply to infections. It can apply to physical injuries too.

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See, when you get sent for a scan, and come back being told that you have bulging discs, or slipped discs, what you don't get told is that degenerative change to the spine is really common in people who otherwise appear perfectly healthy and don't think they have any back problems.

There was a big systematic review of this information, and it produced some really interesting findings. 37% of 20 year olds, 52% of 30 year olds, 68% of 40 year olds, 80% of 50 year olds, 88% of 60 year olds and 93% of 70 year olds who reported having no back problems displayed disc degeneration through an MRI scan.

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30% of 20 year olds, 40% of 30 year olds, 50% of 40 year olds, 60% of 50 year olds and 69% of 60 year olds, who reported having no back problems, were shown to have some degree of bulging to their discs in their spine.

When we are told something is wrong, we automatically assume the worse...especially since health professionals will often dumb things down because they are trying to help! Disc degeneration is often reduced to "crumbling spine"...hardly any wonder you'll sit down and not move if you're told that's happening....even if before the scan you didn't think anything was wrong.

Bulging discs sound even more scary, doesn't it? Is it going to pop out of your back, or burst? What does that mean? What you probably won't be told is that if 60% of perfectly healthy 50 years old have bulging discs.

MRI scanners are awesome bits of kit. They keep getting better and better....like TV cameras. 50 years ago, TV cameras weren't able to pick up lots of detail, and even if they could, your TV couldn't display it. Now we have HD filming, and HD TVs, and talk show hosts are all upset because now their spots and pores and stray facial hair can be seen in glorious high definition! They were always there...we just couldn't see them before.

MRI scanners are the same. We can see more than ever before tiny changes, and although we shouldn't get freaked out about them, and we shouldn't let the results of spinal scans affect our lives, of course we do. And then we slip into a downwards spiral of "I can't" and "I'd better be careful" and "It might go"...and before you know it, all exercise and activity stops and then we end up in actual trouble that we wouldn't have got into at all if we only hadn't had the scan.

Its why the BMJ advises against scans for certain types of musculoskeletal conditions...if it does show anything it is likely to actually do more harm than good.

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So what does all this mean if you're suffering from musculoskeletal pain? What should you do? At the risk of sounding unhelpful, try not to let it take over your life, if you can avoid it. There’s absolutely no reason not to see your GP (or your friendly soft tissue therapist!) but remember that if a scan comes back showing a problem, its likely to be very common and was there before you have the pain (rather than assuming it's the cause of it).

This is why at State 11 we try and help you think differently about any ongoing or chronic injury. We're really proud of how we incorporate a positive and enabling mindset into what we do and we think it's vitally important, just as much as a stretch we might put into your hamstrings or applying some tape to your shoulder. So for us, it's not a "bad" back, it's just a back that's painful at the moment. It's not a "dodgy shoulder", it's just a shoulder that is in need of some support. And most importantly, you aren't a collection of symptoms and aches. You're a whole person, and our job is to support you getting better.

Further reading: Here's the systematic review we mentioned:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/