Back Pain: When to See a Doctor and Whether to Get an MRI First

So, let's imagine that you are 'a little over 20', you are young and healthy, and suddenly back pain appears in your life. Thoughts race through your mind:

• Isn't it too early?
• Will it be like this forever?
• What if it's a herniated disc?
• Should I get an MRI?

You input your symptoms into a neural network, and it gives you some 'scary diagnosis', and of course recommends an MRI. You get the MRI, see 'scary words' (like 'degenerative-dystrophic changes... Schmorl's hernia...'), and in a panic, you rush to a neurologist. The neurologist looks at the report and realizes: the patient wasted money (and time) for nothing. What happened?

The fact is that most often, back pain is nonspecific: it is caused by damage to the muscles, ligaments, or joints of the spine. This type of pain is not life-threatening or harmful to health, but it causes a lot of discomfort. And most importantly - an MRI is absolutely unnecessary for its diagnosis! Only an examination by a neurologist is needed, as the doctor will determine during the appointment whether there are indications for an MRI or not.

- Doctor, but they found a herniated disc on my MRI - do I need surgery? And I probably shouldn't engage in physical activity? Should I maybe go to a clinic that specializes in hernia resorption?

In short, no. A herniated disc or protrusion (a smaller hernia) can be a coincidental finding on an MRI, and the pain itself may be caused by something else (for example, a spasmed muscle). The fact is that between our vertebrae, there are discs made of cartilage that provide cushioning for the spine. With age, all people experience 'drying out' of these discs, causing them to become compressed between the vertebrae - this bulging is what is called a hernia. Hernias themselves do NOT cause pain because they have no nerve endings, and if any person over the age of about 20 (even without pain) gets an MRI, it is likely that a hernia will be found somewhere. Our skin, hair, and nails change with age - the spine undergoes similar changes.

If a hernia is indeed the cause of the pain, it means that it is pressing on a nerve root (a piece of nerve that exits the spinal canal and innervates, depending on its location, the limbs, torso, and several organs). Then, in addition to pain, there will be a characteristic symptom complex for radiculopathy (loss or decrease of reflexes, strength, sensitivity, etc. - what the neurologist determines during the examination).

But even if a hernia is the cause of the pain, surgery is not indicated for everyone and not always. After all, hernias can resolve on their own - and this is NORMAL. Unfortunately, this is how 'gurus' of hernia resorption work with their 'proprietary' methods. Remember: the only way to accelerate the resorption of a hernia is through adequate physical activity, therapeutic exercises, and lifestyle modification. By the way, these same methods are also crucial in treating nonspecific back pain (muscles, ligaments, joints).

This means that there is no 'magic pill' that will relieve you of back pain forever. Yes, pain relievers may be prescribed in courses during flare-ups, and for chronic pain syndromes - even antidepressants. But the most important role will be played by your physical activity, which a neurologist can help you appropriately tailor. Therefore, when experiencing back pain, your first task is to consult a neurologist (or a general practitioner for a referral to a neurologist) - and the doctor will be able to determine the further examination and treatment strategy, as well as inform you about the necessary exercises for your back.