 A disc bulge can certainly contribute to low back pain, but the presence of a disc bulge on MRI does not automatically prove that it is the primary source of the patient's symptoms.” Why Treating the Whole Back May Be More Important Than Treating the MRI Written and Presented by Dr. Masoud Shamaeizadeh, DC Soft Touch Chiropractic – Porter Ranch & Northridge, CA A patient develops low back pain and visits a chiropractor, orthopedic doctor, or primary-care physician. An MRI is ordered. The report comes back: “Lumbar disc bulge.” From that moment forward, something often happens: the disc becomes the entire focus of treatment. I have been guilty of this myself. Earlier in my career, when an MRI showed a bulging disc, it was easy to assume we had found the explanation for the patient's pain. With experience, however, I learned an important lesson: Finding a disc bulge is not necessarily the same as finding the source of the pain. Disc Bulges Are Surprisingly Common—even Without Pain One of the most important studies on this subject was a systematic review published in the American Journal of Neuroradiology. Researchers examined imaging findings in 3,110 people without symptoms and found that disc bulges became increasingly common with age. Approximately 30% of asymptomatic 20-year-olds had a disc bulge, increasing to 84% by age 80. In other words, many people are walking around with disc degeneration or bulging discs and have no back pain at all. You can read the research on disc bulges in people without back pain. This doesn't mean a disc bulge should be ignored. A disc problem can sometimes irritate or compress a nerve and contribute to low back pain, sciatica, numbness, tingling, or weakness. It means something different: The MRI must be interpreted together with the patient's symptoms and physical examination—not by itself. Your MRI Is a Picture, Not the Whole Diagnosis An MRI provides valuable information about the structures of the spine, but it doesn't show everything involved in how a person's back is functioning. Low back pain can involve a combination of factors, including:
What I Changed in My Approach to Low Back Pain Over the years, my approach at Soft Touch Chiropractic has evolved. Instead of asking only: “How do we treat this bulging disc?” I now ask: “What are all the factors that may be contributing to this patient's pain and loss of function?” That means examining the patient—not simply treating the MRI report. I evaluate areas such as spinal and pelvic mechanics, joint mobility, muscle tightness and weakness, posture, movement, flexibility, and neurological symptoms while also considering relevant MRI findings. Treatment can then be individualized according to what the examination reveals. The goal is not to ignore the disc. The goal is to avoid ignoring everything else because we found a disc.This broader approach has been much more useful in my clinical experience, particularly for patients whose symptoms cannot be fully explained by their MRI findings. Why a More Comprehensive Approach Makes Sense Modern low-back-pain recommendations increasingly recognize that persistent back pain is often multi-factorial. The World Health Organization's recommendations for chronic low back pain include education, exercise and certain physical therapies—including spinal manipulative therapy and massage—as potential components of care, depending on the individual patient. At our office, you can learn more about our approach to low back pain and muscle spasm treatment in Porter Ranch and Northridge. The Take-Home Message If your MRI says “bulging disc,” don't panic—and don't ignore it either. A disc bulge may be an important part of the clinical picture, especially when the location of the disc abnormality corresponds with neurological symptoms and examination findings. But it may also be an age-related finding that is only one piece of a much larger puzzle. Treat the patient, not just the MRI. That means looking at the disc and the muscles, joints, movement, strength, flexibility, neurological findings, lifestyle, and other factors that may be contributing to the patient's symptoms.  Low Back Pain or Bulging Disc?
Get a Comprehensive Evaluation If you have been diagnosed with a lumbar disc bulge, low back pain, sciatica, muscle spasm, or chronic back pain, we can evaluate more than what appears on your MRI. At Soft Touch Chiropractic in Porter Ranch, CA, our goal is to identify the different factors that may be contributing to your symptoms and develop an individualized conservative treatment plan. Learn more about Soft Touch Chiropractic and our approach to back pain care. Soft Touch Chiropractic Dr. Masoud Shamaeizadeh, DC Porter Ranch / Northridge, California Call: 818-831-0100 This article is for educational purposes and is not intended to replace an individualized medical diagnosis. New bowel or bladder dysfunction, saddle numbness, progressive weakness, significant trauma, fever, or other concerning symptoms associated with back pain require prompt medical evaluation.
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