Why we should think carefully before slipping under the surgeons knife. Pain 4.

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Well, his shoulder joints are not particularly stressed.

So far the pain blogs have looked at straightforward pain – a major toe stubbing incident results in immediate hopping about, and seeing our toe going alarmingly red and swollen, which will cause us even more distress if we are off out for a night of dancing.  Toe stubbing represents a good example of acute pain.  On the other hand, back ache can represent a good example of chronic or long term pain.  On a recent Z health course, I learnt the fascinating fact that a back can be in a pretty dreadful state – and the back’s owner be living in a state of blissful ignorance.  So this blog looks at pain-free damaged joints and the need to think carefully before going under the surgeon’s knife – and the fun starts with MRI scans.

An MRI scan enables the surgeon to see where the problem lies so he can sharpen his scalpel and get stuck in.  It all seems pretty straightforwards: patient presents with backache, bulging disc clearly seen on MRI, chop a bit of the disc off, job done.  However, increasingly surgery to help, say, a dodgy knee, has been questioned as to its effectiveness and some surgeons curiosity has been piqued enough to start looking at apparently healthy backs – and shoulders – to see what the MRI shows.

Here is a link to an article by Dean Moyer, author of Rebuild your back.  He cites a study published way back in 1994 done on MRI scans of 98 people’s backs who did not have back ache.  Added to the 98 were the scans of 27 people who did have back ache. The professionals reading the scans were told nothing about the pain status of any of the patients.  The results were extraordinary.  Of the 98 people with no back pain, 52% of them had a disc bulge at at least one level (whole disc bigger than it should be), 27% had a protrusion (a bit of the disc bulging out), 1% had an extrusion (supposedly an excruciatingly painful event) and 38% had some abnormality with least 1 disc.  Only 36% had normal discs at all levels.  64% of the subjects had disc problems that would normally lead to surgery to fix the problems – but they had no pain.1.  Dean Moyer cites other studies that found the same sort of thing.  The conclusion of the study states

On MRI examination of the lumbar spine, many people without back pain have disc bulges or protrusions but not extrusions.  Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.

In other words, since 1994, some health professionals have been questioning whether disc bulges and so on really cause back ache or whether the cause lies elsewhere.  The explanation given by pain experts such as Lorimer Moseley2 is that the brain does not perceive these disc problems to represent a threat to the survival of our body and feels no need to raise the alarm of pain.  Dean Moyer makes the point that most disc issues resolve themselves without resorting to the drastic extreme of surgery.  As it happens, I am currently writing a couple of blogs about the essential fatty acid, GLA, and came across a 2009 study, cited on Charles Poliquin’s website, that showed that taking GLA along with ALA helped rehabilitate back pain, again without resort to surgery.3

The question about the need for surgery following the findings of an MRI scan has been raised in regard to that other popular form of surgery – shoulder surgery.  The NY Times article on MRI Scans, published October 2011, reports on the orthopaedic sports surgeon Dr James Andrews of Birmingham, Alabama deciding to conduct some MRI scans on 31 perfectly healthy professional baseball pitchers’ shoulders, men playing currently without pain.  Dr Andrews found abnormal cartilage in 90% of them and abnormal rotator cuff tendons in 87%.  Gina Kolata, the NY Times author, quotes Dr Andrews as saying

If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI.

So if we get referred to an orthopaedic surgeon and sent for an MRI scan, the chances are very high that the surgeon will find some abnormality in the troublesome joint and want to operate, but in truth, most injuries heal with if given decent care and the surgeon should pocket his knife.  And furthermore, various joints in our body can be in quite a state but we live pain free, oblivious to any underlying problems:  the brain only generates pain when it thinks we are under threat.    To be told that our discs are crumbling or bulging or degenerating sounds quite dreadful – but the truth is that most people’s discs are in a state, especially as we age.  So such news should not be a cue to start panicking and wrapping ourselves in cotton wool for fear of further injury, but a cue to start to look after ourselves properly and seek out the people who can help us.  And those people will have a Z-health qualification.



  1. Jensen M C.  Bran-Zawadzki, et al.  Magnetic resonance imaging of the lumbar spine in people without back pain.  New England Journ. Med. 1994; 331(2): 69-73 []
  2. David Butler and Lorimer Moseley.  Explain Pain. []
  3. Ranieri M. et al The use of ALA and GLA and rehabilitation in the treatment of back pain: effect on health-related quality of life.  Int Journ. of Immunopathol. Pharmacol. 2009 Jul-Sept; 22(3 suppl): 45-50 Abstr []

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