| Have you or a loved one ever been in that | | | | nerve root canals. The researcher's conclusion? |
| uncomfortable position of asking a health provider: | | | | "Degenerative disc disease is a common finding in |
| "What is the cause of my back pain? | | | | asymptomatic [pain-free] adults..." |
| "...shoulder pain?" | | | | Pain and the Cervical Spine (Neck Region) |
| "...neck pain?"or some other painful condition? And your | | | | Next up, a more recent study, reported in 2005 in the |
| well-meaning nurse, doctor, or physical therapist was | | | | European Journal of Radiology (PubMed). This study |
| kind enough to do a "diagnosis" with an MRI or X-Ray, | | | | examined the cervical spine of 30 pain-free individuals. |
| solemnly telling you afterward that the cause was:torn | | | | The cervical spine is the seven vertabrae at the top of |
| rotator cuffdegenerative disc diseasedisc protrusionor | | | | your spine, beginning at the base of the skull and |
| some other scary and official sounding "cause"? And | | | | ending near the top of your shoulders. Again, 30 |
| those explanations sound convincing, do they not? If a | | | | people who have no reports or history of pain near |
| person has intense and recurring back pain and | | | | the cervical spine likely have no structural problems in |
| someone shows them an x-ray with a herniated disk | | | | that area, right? |
| that disk must be the cause, right? After all, | | | | Au contraire. |
| SOMETHING must be causing the pain. It is difficult to | | | | An astounding 73% of the sample (22 of 30) had a |
| not associate pain that with some type of structural | | | | "bulging disk"! Fifty percent of the sample had a "disk |
| abnormality...especially when someone who is | | | | protrusion". The thought occurs to me that if the |
| supposed to be an authority on pain tells you so. | | | | majority of the sample had a bulging disk perhaps |
| But do structural anomalies cause pain? | | | | having a bulging disk is normal? In that particular sample |
| Is it true that disk protrusions, torn rotator cuffs, | | | | it certainly was not out of the ordinary. Let's do one |
| herniated disks and the like actually cause pain? It's not | | | | more. |
| a trivial question. If a surgeon believes a spinal problem | | | | Shoulder Pain and the Rotator Cuff |
| is causing a pain symptom, he or she may want to | | | | This one is from the Annals of The Royal College of |
| conduct an expensive and invasive surgery to "fix" the | | | | Surgeons of England and was published in 2006 |
| structural "problem." The "cure" could cost tens of | | | | (Full-text online: Dead Men and Radiologists Don't Lie). |
| thousands of dollars and require months of | | | | This study is a review study, meaning they did a |
| recuperation. It might be nice to know if structural | | | | review of many different studies that had already |
| abnormalities are a necessary and sufficient cause of | | | | been conducted. They reviewed the prevalence of |
| pain. | | | | rotator cuff tears in people who had reported pain and |
| I'm not going to directly answer the question of | | | | people who had not. Interestingly, they reported on |
| whether so-called structural problems cause pain | | | | studies of living people as well as cadaver studies of |
| symptoms. You will have to be the judge. I will give you | | | | people who had died. In the cadaver studies, on |
| some information from several studies that | | | | average, people who had pain symptoms in the |
| demonstrate how many people with structural issues | | | | shoulder area had rotator cuff tears at a rate of 42%. |
| are, in fact, pain-free. In other words, the research | | | | Meaning that only 42% of those who were in pain had |
| shows that some people have pain "causes" and yet | | | | a rotator cuff injury. And for those without any pain? |
| do not report pain symptoms. Let's begin. | | | | About the same: 39% of them had injuries. |
| Pain and the Lower (Lumbar) Spine | | | | The study of living people was a bit different. |
| The first research I will cite was conducted in 1991 and | | | | According the the studies 26% of pain-free people |
| reported in the Journal of Neuroimaging (Magnetic | | | | had rotator cuff injuries and 49% of those in pain had |
| resonance imaging of the lumbar spine in | | | | injuries. The researchers concluded that "rotator cuff |
| asymptomatic adults. Cooperative study--American | | | | tears demonstrated radiologically during investigation of |
| Society of Neuroimaging,1991 Feb;1(1):2-7.). The | | | | the shoulder may well not be responsible for the |
| researchers used magnetic resonance imaging (MRI) | | | | presenting symptoms." In plain english, rotator cuff |
| to examine the lumbar spine (the lower part of the | | | | injuries might not be the cause of pain symptoms. |
| spine) of 66 asymptomatic people. Asymptomatic | | | | You've got the take home message by now? |
| means they had no back pain. | | | | According to the research, pain and structural |
| Given that they had no back pain, they had structurally | | | | problems are not necessarily related. Be wary when |
| perfect lower backs, right? | | | | someone tells you that they are, even if they have an |
| Not so fast. | | | | X-Ray or MRI scan to "prove" it. Get a second opinion. |
| Twelve of the people in the study (18%) had either a | | | | Look for other factors. |
| disc protrusion or a herniated disk of some kind. | | | | I am not a medical doctor, nor am I giving medical |
| Twenty-six of the people in the study (39%) had a | | | | device. I am merely reporting on the literature that has |
| bulge that could associated with degenerative disc | | | | been produced. Do not make any medical decisions |
| disease. In addition, there were many other structural | | | | based on my opinions. |
| issues found, including spinal stenosis, and narrowed | | | | |