National specialists on back pain have commented that many people have a very mechanical view of how the human body works, and think it’s like a car. If a part is worn or broken, it can be easily diagnosed, replaced, and completely fixed with a new component, and the owner will never have to worry about that part again. Our living bodies do not work this simply. In a human being, pain and other sensors are too tiny and numerous to see, and the network of spinal cord and brain “computers” is too complicated for even our most advanced technology to understand. Preventive maintenance (like exercise, weight control, and stress management) also need to be done ever more frequently especially as our bodies get older.
In every human being, the brain and spinal cord receive signals from nerves and pain sensors and then send other signals out to muscles to control arms, legs, and spine movement. These signal patterns have developed over years, and explain how we learned to walk, run, ride a bicycle, dribble a basketball and play a musical instrument. The signal patterns constantly update the spinal cord to include the status of sensors that detect our muscle flexibility, strength, and endurance. We think chronic pain starts when these sensors in your muscles (peripheral signals), “mis-fire” or malfunction, and the computers in your brain and spinal cord (central signals) do not adapt to those improperly functioning sensors. The larger peripheral nerves that exit the spine can easily be seen on an MRI. Only in some cases where the large nerve root exiting the spine is compressed would surgery be necessary to relieve the “pinched” nerve. However, most “pinching” sensations come not from nerves that are pinched, but from muscles that spasm exactly when their muscle fibers line up in the direction that they are called to move.
Finding the microscopic nerve endings that arise from painful muscles is not currently possible even with our advanced technology. Painful muscles and non-painful muscles appear exactly the same on MRIs. Many patients who have painful back muscles are told by their doctors that their pain is coming from disc bulges or tears that look abnormal on their MRIs.
Despite what you may have been told about your spine, research shows that chronic back pain frequently does NOT correlate with the structural abnormalities that may have been seen on MRI. Many people without back pain also have disc degeneration, disc tears, and bulging discs. We at the UI Spine Center encourage you to focus on how your spine muscles, nerves, spinal cord, and brain are functioning rather than how they look on an MRI.
Department of Orthopedics and Rehabilitation
University of Iowa Hospitals and Clinics
200 Hawkins Drive
Iowa City, IA 52242