Why does “mild” back pain hurt so badly?

As a Chiropractor, I see back pain everyday. Actually, back pain is the number 2 reason why people go to a Medical Doctor in America. Now this is not an insult to medicine as I believe there is a place for medicine, but most MD’s are not adequately trained in musculoskeletal conditions. Don’t believe me? Click here. I often have patients come in telling me “My doctor told me I have a pinched nerve”. Ok, so did your doctor tell you what exactly is pinching the nerve? To this day I haven’t heard anything but a “no” for an answer.

Pinched nerves can be caused by several things but 99% of the time it is either inflammation, a disc bulge/ disc herniation, or combination of both.

I do tell patients that no one says mild doesn’t hurt. It’s not funny. Mild can hurt really bad on some people and severe may not hurt at all on others. I’ve seen it. There is however a scientific rationale behind why mild can hurt so badly. It all comes down to a discovery of a nerve that actually innervates the back end of the disc which is the part that bulges. That nerve is called the sinuvertebral nerve. Below is a picture of the sinuvertebral nerve as marked by SN.When a new patient comes to me with a disc problem and has seen a MD, they often have a MRI cd with them. MRI is such a wonderful, yet unfortunately expensive procedure. An MRI will show far more about the body than the 100 plus year old x-ray technology, such as how many millimeters is the disc bulge or is it a disc herniation (for those that need to know, bulging and herniation are treated in the same way chiropractically). Many times the radiologist who read the MRI may simply describe the disc as mild, moderate or severe bulging. Sometimes I see mild disc bulge, no impingement on nerve root. Everytime I read that to a patient I hear the same response, “then why does it hurt so bad Doc?”. That’s a good question. Why?

By looking at this picture we are able to see why lower back pain can hurt without the disc having to impinge the “IVF Zone” denoted in red. The sinuvertebral nerve will pick up tears in the annulus fibers of the disc, sending that information to the brain.

Another reason why “mild” can hurt so badly is that the disc bulge really isn’t “mild” at all. Newer technology has emerged in the MRI field so that more accurate images of the spine can be produced, by sitting. Why is this important? Because sitting and bending forward is the most stressful position for the disc. We call is disc loading. The least pressure you can put on your disc is to lie flat on your back. This happens to be the same position which the MRI was performed. Let me put this into perspective. If you went into the hospital and needed a stress test on your heart, the hospital wouldn’t put you in a recliner and say “ok looks pretty good”. No, they would put you on a treadmill, and see how much your heart can handle. Same idea, to test the disc accurately, they need to be stressed. Sitting bending forward is the most accurate MRI possible. However, there is not many of them in the US due to the costs. The image below shows the increase in disc loading with standing being the point of reference at 100%. Lying down is a mere 25% disc load, great for patients, bad for analysis. Sitting bending forward results in a 85% more load placed on the discs. Great for analyzing the how healthy the lower back is.

Your Grand Rapids Chiropractor, Dr. S