Intervertebral Discs can displace, seen on imaging such as magnetic resonance imaging as a bulge, herniation, or prolapse, yet the correlation with clinical pain can be poor (1). In the past large disc displacement has been an indication for surgical intervention (2). Large imaging studies have shown that disc displacement is not uncommon in those without pain (3). Surprisingly, back pain, sciatica and lower back disability neither increase progressively with age nor correspond to age related changes of disc degeneration (4).
The question of what to do and when for people, within a pain experience who have been shown they have a disc defect, for the best, has been long standing. Following people with MRI confirmed massive disc displacements over 7 years has demonstrated a natural history not proven before. Discs can naturally resolve, repair and resorb without surgery (1).
Pain is a socioemotional experience that English medical culture ‘treats’ with a diagnosis (socially impacting sympathetic behaviour of those close to the patient), followed by a physical intervention to resolve identified defect. Finalised with a declaration of defect free. A surgical only approach to a back pain experience seems to cover the socioemotional aspects, or pain experience, by focussing upon a disc displacement that is not well correlated with the pain experience being ‘treated’ (3).
As a chiropractor I respect the nature of muscle and joint pain experiences and provide physical interventions with social and emotional support as soon as I can. Fulfilling the definition of compassion, an NHS core value.
- Benson R et al (2010) Conservatively Treated Massive Discs. Ann R Coll Surg Eng 92 147-153
- Postacchini F (1996) Results of Surgery Compared with Conservative Management for Lumbar Disc Herniations. Spine 21 1383-7
- Brinjikji P.H. et al (2014) Systematic Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol 10.3174/ajnr.A4173
- Bergmann TF et al (1998) Manipulative Therapy in Lower Back Pain with Leg Pain and Neurological Deficit JMPT 21 (4) 288-94