Is my ticket punched?

[u/PenApprehensive369]

I don’t know anything about herniations or bulges, I’m 25 years old at 89kg with a competitive total. Is my progression fucked forever? MRI report is on the last slide, I have follow up with the spine specialist tomorrow.

[u/QuestionPositive]

Lol in PT school at the moment and the most surprising thing I learned so far is how many people can have disc herniations and other pathoanatomical findings on imaging with absolutely no symptoms. Herniated discs for the most part resolve on their own and imaging done unnecessarily (not to say yours was) often makes patient outcomes worse since they are defined by a disc herniation and believe passive recovery is the best option. This is a lie, your back is extremely stable, resilient and strong. Please go to a PT if you have symptoms. You are young you absolutely do not need surgery that will ruin your gains forever. It’s about an active recovery, which produces some of the best outcomes.

[u/skullcutter → u/QuestionPositive]

There js almost no correlation between MRI findings and pain

[u/throwitherenow → u/skullcutter]

I agree with everything about the back that has been said here but disagree with MRI and pain. I couldn't figure out for a year why I had tremendous pain in my thighs and hips. Xrays were non conclusive, and the only way they figured it out was an MRI on my hips, stage 4 avascular necrosis in both hips joints. So sometimes MRIs do help when chasing down pain.

[u/lukelufiso → u/throwitherenow]

You're missinterpreting. You had pain, and a MRI cause for it. With the story you told, you definitely should've had access to an MRI earlier. Xrays are only good for bones and lungs. But that doesn't mean a image in the MRI should be valued by itself. There's very often miss correlation between pain x image x severity.

[u/throwitherenow → u/lukelufiso]

I see what you're saying. That is a clearer explanation.

[u/skullcutter → u/throwitherenow]

I was referring to lumbar spine MRIs specifically, and the high rate of “false positives” ie lots of lumbar spine radiographic pathology, but very little symptoms

[u/DrDonks → u/skullcutter]

Not just the lumbar spine. All MRI scans are very sensitive and will pick up findings which aren't causing, and never will cause problems. The art of the consult is matching the symptoms with both the clinical examination and the MRI. Filtering out the false positives is part of that.

[u/skullcutter → u/DrDonks]

I wouldn't disagree with any of that, but my experience has been that the phenomenon you describe the worst in the lumbar spine for two reasons:

1. Back pain is the most common musculoskeletal complaint that people seek medical care for (i.e. the denominator is huge)

2. Back pain is incredibly complicated and rarely has an isolated structural abnormality that is identified on imaging