What we see above is a table of imaging results from investigations conducted on asymptomatic individuals. These are people who have no symptoms. Yet we see what we see above.

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Two of most interesting lines to me are ‘disc degeneration’ and ‘disc bulge’.

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The very first part of the table shows that 37% of people in their 20’s have disc degeneration. 37%! That’s more than a third. Your first thought might be that this a lot of people with degeneration, but it should really be this:

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Surely there isn’t 37% of the 20-year-old population with limiting back pain?

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And you’d be right, because there isn’t. Remember, all of the people in this study had no symptoms.

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No pain.

 

So that means 37% of young people have degeneration and no pain. 30% of them have a disc bulge. Still no pain.

 

If we move up the other end 96% of 80-year-old have disc degeneration, and 84% have a disc bulge. Now obviously as you get older these would be more common, but remember, these people are asymptomatic. Even if they weren’t, I’m sure 96% of 80-year-olds don’t have crippling back pain.

 

So what’s going on?

 

It comes back to threat.

 

As we’ve seen, whenever the body produces a pain experience, it feels there is a threat or potential danger. Which means what is actually going on structurally is only part of the picture. If you have disc degeneration in your spine, yet your body doesn’t see this as a threat, why would it be worth you experiencing pain? The same would go for any disc bulge.

 

Quite often, if these changes happen slowly over time, then they may be seen as less threatening then something like a sudden spinal fracture, so pain is a less likely outcome.

 

Now that isn’t to say that someone who has degenerative change of the spine, or a disc bulge, won’t experience pain. It’s more saying that having any of these things listed on the table show on imaging does not guarantee that is the reason you have pain.

 

Strange Diseases

 

While I’m on the topic, I thought it would be worth touching on something which I see occasionally come through. I would have thought this would no longer be happening, but it still seems to, and I think it is quite misleading.

 

And that is the diagnosis of ‘Degenerative Disc Disease’.

 

Occasionally someone comes up with an X-Ray report which has this diagnosis on it. Less than there used to be, but it still happens.

 

Firstly, this is not a real thing.

 

By that I don’t mean degeneration doesn’t happen, I just mean that it’s not a disease.

 

Calling it a disease implies that it is abnormal, dangerous and likely to worsen.

 

You know what it is? Normal.

 

It is generally the normal aging of the spine. Look at the table above. 37% of 20-year-olds have degenerative discs, and that gets higher as we get older. Over this time, natural changes occur due changes in stresses on the spine and the body’s response to these. Most of the time this doesn’t result in pain.

 

The big problem I have with it is this. If you were someone who has had a bit of niggling back pain, or even some ongoing back pain, and you have an X-Ray which gives you this diagnosis, how might that affect your pain? Is it going to help? Not likely. What it might do is make you worry, it might make you change the way you move, or even develop a fear of hurting it further. If we look back at the way the brain is involved in pain, do you think it might now seem more of a potential threat?

 

I would think so.

 

I’m not saying the information isn’t helpful sometimes, but it needs to be explained well and understood, often so you don’t think your back is worse than it is. As Dr Stuart McGill (the Canadian Professor of Spine Biomechanics, not the cricketer) once said:

 

“A ‘degenerative disc disease’ diagnosis is the equivalent of telling your mother-in-law with wrinkles that she has “degenerative face disease!”(5).

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I feel it would be a brave (or foolish) person to do so.