A tale of two papers about structure and back pain

Paul Ingraham

This is about a fascinating pair of papers by the same group of researchers, Brinjikji et al., who looked at a whole lot of MRI pictures of spines. The first paper presents evidence that signs of spinal degeneration are present in very high percentages of healthy people with no problem at all.

Good to know.

The second paper presents evidence that degenerative features visible on MRI are nevertheless “more prevalent in adults 50 years of age or younger with back pain compared with asymptomatic individuals.”

Also good to know.

Delicious cognitive dissonance? The take-home message is actually just a nice, reasonable compromise between two well-known viewpoints: degenerative changes matter less than many patients and professionals still assume, and are not an adequate foundation for many popular treatments, but they do still matter. Duh.

I’ve written deeply on this topic, particularly in one of my best known articles: Your Back Is Not Out of Alignment: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. I’ve now updated that article with these citations.

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