Derek S. do structural issues matter or not?

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Question

Hello,

The book mentions you should rule out structural problems (at the beginning of the book). But later in the book he says structural problems like herniated discs don't matter. I'm a bit confused by this?? Do they matter or not for pain?

For example I have gotten MRI that says I have things like spinal stenosis, herniated discs, potential contact with nervelet (these are from Cervical MRI). I do not have the MRI for other parts like thoraccic or lumbar but I have similar pain symptoms in other regions so I believe I probably have herniated discs in those regions too [combinations of aches, burning pain, sometimes sharp shooting nerve pain, etc]. With my lower back it obviously hurts if I sit for too long, but when standing for too long it hurts as well.
Just got back into town after hours of driving to evacuate for hurricane and my lower back is hurting more than it ever has before. My normal dose of NSAID and Muscle Relaxer is not working.

I work with computers so I have had low back pain for a while (couple years). I turned 30 this year, and in combination with multiple lifting injuries (picking up heavy subwoofer from ground) I have developed the pains and problems in the other areas (thoraccic and cervical). I did not have pains in T & C before this year.

Would love some insight on this as it's really quite terrible.

 

[Derek Sapico MFT]

Answer

Thanks for your question.

It is important to make the distinction between "structural problems" and "incidental findings." Things like disc degeneration, spinal stenosis, and herniated discs are often incidental findings. In other words, if you have back pain and get some imaging done, they will usually find some kind of "normal abnormality" that will be cited by many doctors as the cause of the pain.

The term "structural abnormality" is broadly used and can refer both to things that need medical attention and to things like disc dessication (which is normal wear and tear and should not require medical intervention except in extreme cases).

I would recommend consulting with a TMS doctor to get clarity on your symptoms if at all possible. Gaining clarity on the cause of your symptoms is a very important part of recovery. Even if you have to fly to another city for an appointment, I think that it is worth it.

Best of luck!

-Derek

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