One of the most frustrating things that I hear on a weekly, if not daily basis, is that “I have a herniated disc causing my back pain so there’s nothing you can do about my back pain. I have to have surgery.” And this couldn’t be farther from the truth! I can honestly tell you that over the course of my entire career, I’ve only come across TWO patients who had a disc herniation bad enough that required surgery – and I’ve treated hundreds, if not thousands, of patients who had disc herniations!
The reason is that disc herniations in themselves do NOT cause pain! Read that sentence again, please, and let me explain. Most people who have severe back pain who do not try quality physical therapy first (not the run-of-the-mill, cookie-cutter PT) and go straight to their PCP or orthopedic surgeon will end up having an MRI. Nine times out of ten, this will show disc herniation, disc bulging, or nerve compression of some sort, which they immediately attribute to causing their back pain. However, over the past 10 years, more and more studies are proving that disc herniations themselves do not cause pain.
These studies are looking at asymptomatic (no symptoms or back pain) people over the age of 40 and giving them an MRI, and the results are mind-blowing! Over 60% of people over the age of 40 consistently show some type of disc herniation, disc bulging, nerve root compression, or degeneration of some sort, YET none of them reported having any pain! Because of this, we cannot say that disc herniations in themselves cause back pain. No ifs, ands, or buts about it. What we can say is that disc herniations can be correlated with back pain, but by no means can we say that they cause back pain.
Blame Your Big Butt…Muscle
What I can tell you, after working with thousands of people who had back pain over the years, is the one common factor among them: glute (your big butt muscle) weakness. Another common factor is SI joint (sacroiliac joint) instability. After strengthening the glutes, stabilizing the SI joint, and doing a little core work, 99.9% of my patients’ back pain resolved! Please notice that I didn’t say anything about working on disc issues…
My thought process is this: Why did the disc herniation happen in the first place? The truth is that disc herniations occur because they become overworked and underpaid due to something (glutes) somewhere else not doing its job correctly. This brings me to our entire treatment philosophy, which is to treat the problem (glute weakness) and not the symptoms (disc herniations as the result of glute weakness). An amazing thing happens when you start treating the problem that’s actually causing your symptoms…you get better!
Try PT First!
Now you may be asking, if it is really that simple, why aren’t all PCPs, PTs, and orthopedic surgeons thinking this way, too? And it’s really quite simple – “Big Pharma” wants to get paid! Think about it: The longer you’re in pain, the more money they make. And even after a surgery that’s supposed to “fix” your pain, it’s extremely rare that someone wouldn’t at least fill the script for pain meds the surgeon eagerly hands over—so they get paid again!
And if that’s not enough to convince you, the results of a study that looked at 472,000 Medicare beneficiaries who received a diagnosis of low back pain in 2014 found that those who chose PT first over injections or surgery spent on average 75% less on their total care. The actual numbers are that those who chose PT first spent, on average, $3,992 to resolve their back pain, compared to those who chose surgery first, who spent an average of $16,195!
For more information on how your health insurance and Big Pharma are not keeping your best interests in mind, check out The Berman Method Podcast or Bermanpt.com!
Dr. Jake Berman, PT, DPT, is a physical therapist and owner of Berman Golf, where they focus on helping aging golfers increase distance off the tee, shoot more consistently, and play more frequently. If you’re not ready to accept “getting old” as an excuse for a poor golf game, call Dr. Berman at 239.431.0232 to take advantage of a FREE 30-minute taster session!