Q&A: TMS or truly bulging disc

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I have had sciatica for about a year now. I done PT, Oral Steroids, Chiropractic, ice and heat. I am at wits end because nothing is working. I have had an MRI and it revealed a slightly bulging disc at L5-S1 that "may or may not be the root of my pain". I have all the symptoms of a bulging disc, but I am wondering now if I have TMS. Any advice you can give me is much appreciated. I guess my biggest question is that if all my symptoms support the L5-S1 bulge, how can it be TMS?

Answer by Georgie Oldfield, MCSP

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Georgie Oldfield, MCSP

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Firstly, there is a lot of research out there to show that slipped discus, degeneration etc found on MRI are just as common with people who don't have pain, i.e normal 'abnormalities'. See brief examples below.

Ann Rheum Dis.2003

From their results they deduced that; “Degenerative disc disease, as seen on imaging, is not a painful condition.”

Masui et al. 2005 (study followed up at 2 & 7 yrs)

‘There was progressive disc degeneration in all patients. However there was no predictive correlation between MRI findings and the continuation of pain.'

Spine 1984: CAT scans in asymptomatic subjects – about ⅓ found to be abnormal

The Journal of Bone & Joint Surgery 1990:

MRI scans of 67 people aged 20 – 80yrs who had never had back problems. About ⅓ of the subjects were found to have a substantial abnormality.

1994 New England Journal of medicine:

MRI of the Lumbar Spine in People without Back Pain – only about ⅓ had normal discs!

This then fits with my findings with my own patients before I came across TMS, in that so many of them became pain free and remained so after very gentle hands on treatments, yet they still had the 'abnormalities' found on MRI. So what what been causing the pain then?

People with TMS have a wide range of symptoms and this may fit in with a previous diagnosis given, or not. The symptoms you have just show which nerve root is being affected, not by pressure from the disc on the nerve, but according the TMS theory, by hypoxia to that nerve root. The "may or may not be the root of the problem" just goes to show that the specialist thought it unlikely your "slightly bulging disc" was large enough to cause the symptoms you have. More of a case for TMS then.

I hope that helps.


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