Have you noticed how everyone around you is suddenly an expert when you tell them that you have hurt your back or neck? After expressing their concern, they begin their subjective assessment of you: What is your diagnosis? Have you had an MRI? Who are you seeing? Do you have sciatica?... They then go on into a ramble on about how their uncle, distant cousin or office colleague sees this particular guy that you should go see. Or how they do this miracle exercise that you should do. It gets worse when you tell them you haven't even had a MRI yet. They look at you in disbelief and shock that you haven't done what is seemingly the most normal thing to do following a back injury. How are you going on to know what is wrong with your back? How are you going to treat it?
Meanwhile, you have actually been to your trusty physio who had diagnosed you through a barrage of objective tests with a minor back injury. It could have been a #1 Sprain (damage to ligaments) or #2 Strain (damage to the paraspinal muscles).
Nothing too serious. You have been provided a clear treatment plan and been reassured that it's not that bad. You need to go through some acute management to promote healing and prevent further damage before the pain will subside (1-2wks). This will be followed up with spinal rehabilitation with the aim of returning you back to full activity (3-6wks).
You trust your physio. It all makes complete sense. However, inside your head you can't help but listen to the million voices offering their opinions about treatment and management. Everyone has offered you some advice from the lady who cleans your apartment building to the security guard who looks after your office building. Even your CEO has noticed you struggling to get out of your chair, and asked you what's wrong with your back. When you tell him it's just a back sprain, you get the kneejerk inquiry “Have you got an MRI?!!”
It all gets overwhelming and you start wonder.. you start to doubt yourself… Am I doing the right thing. Maybe they are right. Maybe I should get an MRI. I mean it's been a week and I'm still feeling pain… I must not be getting any better.
You are conflicted. You feel down and depressed. You even feel guilty because you know your colleagues and friends mean well. You are psychologically affected and as a result more pain focus, and unsurprisingly your pain “seems” worse.
This patient came in to see me and I advised her to stop listening to her family, colleagues, strangers and trust me for all back related matters. She comes in a week later, and surprise surprise. She's feeling better. Pain is minimal and basic spinal control is coming back and we even commence some basics spinal rehabilitation which brings her confidence back! She sees that she is on the mend, getting better and there is light at the end of the tunnel…
Wow… that went for ages. I guess the take home messages here are:
#1 Trust your physio or health practitioner and don’t listen to non-experts (family & friends)
#2 More importantly and the actual reason I began this rant, as much as MRIs are the gold standard for spinal injuries, they are over prescribed and can actually be misleading. Studies have shown that if you take a healthy (pain free) group of individuals and perform an MRI on them, MOST of them will actually come back with results of disc degeneration, or a disc bulge. It is all part of the aging process so don’t beat yourself up and confine yourself within the limits of your MRI diagnosis!