American College of Physicians
Back Pain Diagnostic Guidelines

by: Dr. Mitchell Yass P.T.

For 18 years, I have been promoting the idea that MRIs are invalid in identifying the cause of back pain. Studies have been showing this fact since the ‘90s and the volume of studies has only increased over the past few years. Studies have shown that in 70% of people with no pain, a herniated disc was found at the spine. Conversely, in patients with severe pain, no herniated disc was found. In more recent studies, as many people with no pain in almost the same percentages as those with pain were found to have spinal abnormalities such as stenosis, arthritis and degenerative disc disease.

Well now The American College of Physicians has taken their concerns about the validity of MRIs for identifying the cause of back pain to a whole new level. In February, the College has now set new recommendations for physicians. They have stated that they no longer recommend the use of MRIs or x-rays to identify the cause of pain based on the incidence of spinal abnormalities. They find that additional testing and treatment does nothing to resolve the pain and simply increases health care costs. The findings were based on a literature search of over 20 years. The findings were extremely strong about the value of MRIs or x-rays. In 85% of cases of patients coming to a primary care physician with back pain, the symptoms could not be attributed to a specific disease or spinal abnormality. It was noted that these tests have not been found to be valid with rigorous testing. And most damming, any attempt to treat back pain based on these findings has done nothing to improve outcomes.

So if spinal abnormalities are not creating back pain in most cases then what is? The answer lies in understanding what exactly is pain... Pain is a signal of a tissue in distress. When a tissue is in distress, there must be a method designed to create a conscious awareness of the distress so the person will attempt to obtain an intervention to resolve the distress. Examples of this are when someone is having pain from a kidney stone. The distress of the kidney activates the pain receptors that lie within the connective tissue surrounding the kidney cells. Resolution of this pain comes from resolving the kidney stone. Pain associated with eating something that is rotten presents the same scenario. Pain at the stomach comes from the pain receptors in the stomach lining identifying the distress of the stomach. Passing the rotten food resolves the pain.

When it comes to the back, the concept is exactly the same. The goal of diagnostics is to identify what tissue is creating the pain signal. Resolve the distress of the tissue and the pain resolves. There must be an ending in the medical establishment of the idea that its goal is to treat pain. In my 18 years of practice, I have proven that the tissue in most cases of back pain creating the pain signal is muscle. The cause of the pain was that the lower back muscle strained due to weakness of other muscles that work in conjunction with these muscles. Once the other muscles strained, it caused the lower back muscles to strain and create pain. Ultimately, targeted strength training of the associated muscles is used to resolve the back pain.

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