The pandemic of L4 L5 problem

 It seems something is wrong with L4 and L5. They just seems to be always wanting to go and not stay "in" like good boys and girls. Not only that unlike bad boys and girls they get caught when they go out in the CCTV- either the simple 5 pixel camera or the 1000 pixel satellite camera.

Lets start from the beginning. If you talked to anyone with a back pain in the last 10 years most of them say something like this : I have spondylosis or some will be very specific- I have L4 L5 problem. Some may even add a timeline- i have L4 problem for the last 10 years. As though it is Diabetes or Parkinson's disease. The patients learn this because "we" the uneducated medical community teach that. We also show them in the MRI, as though we have found the black hole and proved Einstein's theory. We should all bow our head in shame for inadvertently ruining a generation of healthy individuals.

Why this is wrong in brief? 

Well the first thing to remember pain is an experience and like any other experience like happiness, sadness, anger cannot be captured in a film (x-ray or MRI) when the cause is not clear. If the cause is clear like "I fell down hard"- it may show in the x-ray as fracture or in the MRI as tear of soft tissue. Some serious pathology like cancer or TB can be visualized in a image. But common low back pain which we all will have on point in time don't have a definitive cause hence may not show in any imaging. They don't show the cause of your pain or source.

Back pains - we don't have the slightest clue how or what causes it. It may sound amazing for many people who think medicine is cutting edge and has evolved so much. Well that's true but many of the precipitating reason or causing reason is not know. We don't know why you get a headache especially if you are not married or have not seen the latest movie from Michael bay or own Atlee (i think thats the untalented wankers name).   We dont know why you get cold. We all think it is because of water- either rain or what you drink or ice cream. we know that is wrong isnt it, We dont know the reason for diabetes to Parkinson's. So it is not uncommon to say- we dont know what is the causal factor. In case of back pain- the answer is WE DONT KNOW.

So it is not caused by L4 L5 or some disc which is out of whack. The idea of all these bones should align perfectly comes from engineering not biology. Look around you, notice how all the living thing look and then look around all the man made non-living things. You might notice, most of the biological systems don't look straight. From the legs to spine, nothing has to be straight or erect. I tell all my patients even the straightest of the trees like coconut trees are never straight. But if a building is crocked like the Pisa tower then it is a marvel. Not for biology.

How can a not straight or erect system be stable?. Well that's the amazing thing which was explained brilliantly by one of the greatest mind ever to live- Charles Darwin. In simple terms the system adapts not the other way around. So when you grow the body adapt to your need, goal and availability. When you start a sport depending on the sport your body will adapt. If you play food ball you grow stronger, with ability to kick harder- irrespective of if you have flat foot, bow knee etc. You may think for football I need a "proper" lower limb", well no it is not. The tree grows in accordance with the sunlight and water not in accordance with the rules of being straight. They adapt- they grow stronger in accordance with the wind. So the system adapts to the need and what it needs to do not just growing "proper" or normal.

    But, Mr. smarty pants I have seen my L4 L5 disc it was out of shape, I have seen the degeneration of the spine joints. The doctor and therapist showed it to me. I am not denying any of that. I am not saying the finding are wrong as an optical illusion. No. These are what we call incidental findings. What are incidental findings? When a doctor orders a test for a reason (to find if we have a particular disease) and then you find another lesion (a problem or disease). These are sometimes very good like you find a small tumor or something which could become life threating later. 

    But many a time incidental findings are over interpreted or just stupidly. When we grow older, all our systems decay. We all have a half life. We are all dying. For us to die our system has to decay. Otherwise as the great Kannadas said there wont be any space if we all keep on living. When the system decays, it also at the same time heals. Again unlike a non-living thing which cannot heal when it decays.

 The decay in the system is accelerated by 100s of factors, but the one factor which is important is "inactivity". Activity makes our system slow down aging. Not the other way around- taking rest does not make you age slow. Aging and decay so visible ,just look at your reflection in the mirror. When you use a powerful mirror- you will see hundreds of changes of ageing or decay. And if you use a powerful rays- then the small changes which are natural are exaggerated and looks abnormal (even though that is a wrong word). So, if you take a x-ray or MRI of people who are in the 30s the spin will look like it has slightly old- with degeneration of  the spine. As you grow older and in the 50 and above they will look like they just came out of the washing machine after 2 hours. Those are normal findings.

I don't know when this will stop. The disc people. the fascia people, the uneven muscle strength people, core people, the x-ray people, the surgery people are not going to change. Patients need be empowered. Hopefully the 5 people who read it become a empowered patient.

So to summarize :  

• We dont know the reason for LBP
• X-ray and MRI for LBP is like testing the purity of gold with a inch scale (that stupid)
• Yes we are the reason - because of greed, stupidity and laziness we have a epidemic of patients who carry a large envelope
• Be a medically literate patient.     

Love

Hariohm