If you've been given an MRI report showing a disc bulge, disc protrusion, herniated disc, nerve compression or spinal degeneration, it can be difficult to understand what it actually means — particularly when the terminology sounds alarming.

An MRI provides detailed images of the structures within your spine, but an MRI finding does not automatically explain your pain.

At Leyton Osteopaths, we look at your MRI findings alongside your symptoms and clinical examination to help determine whether the findings are likely to be relevant to your condition.

This is particularly important when considering treatment for back pain, sciatica, disc problems or nerve-related symptoms.

What does an MRI show?

Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to produce detailed images of the body's internal structures.

For spinal problems, an MRI can provide information about:

• The intervertebral discs
• The spinal cord and nerve roots
• The spinal canal
• The joints of the spine
• The vertebrae and surrounding bone
• The spaces through which the spinal nerves travel
• Changes associated with ageing or degeneration
• Certain injuries and other abnormalities

An MRI can therefore provide valuable information about the structure of your spine.

However, an MRI is a picture of your anatomy, not a direct measurement of pain.

Why can an MRI look abnormal when someone has no pain?

This is one of the most important things to understand about spinal MRI scans. Changes to the discs and other structures of the spine become increasingly common with age. Some of these changes can be seen on MRI in people who have little or no back pain. This means that finding an abnormality on an MRI does not necessarily mean that the abnormality is the cause of your symptoms.

For example, you could have a disc bulge on your MRI without that disc being responsible for your pain.

Equally, a disc problem that is affecting a nerve may be highly relevant if it corresponds closely with your symptoms and clinical findings.

The important question is therefore not simply "What does my MRI show?" but "How does what my MRI shows relate to my symptoms?".

Common terms used in spinal MRI reports

Disc bulge

A disc bulge occurs when a disc extends beyond its usual margins.Disc bulges are relatively common, particularly as we get older, and they do not necessarily cause symptoms.

The significance of a disc bulge depends on factors such as its location, extent and relationship to surrounding structures, as well as whether it corresponds with your symptoms.

[Learn more about Bulging Discs →]

Disc protrusion

A disc protrusion describes a more focal extension of disc material beyond the normal boundary of the disc. A protrusion may or may not affect a nearby nerve. If a nerve is irritated or compressed, symptoms may include:

• Leg or arm pain
• Numbness
• Tingling
• Altered sensation
• Weakness

The location of the protrusion is therefore important.

Disc extrusion

A disc extrusion is a type of disc herniation in which disc material extends further beyond the normal disc margin. The terminology used in MRI reports can vary, and the significance of an extrusion depends on its size, location and relationship with nearby structures.

An extrusion does not automatically mean that surgery is required.

[Learn more about Slipped & Herniated Discs →]

Nerve root compression

CYour spinal nerves leave the spinal canal through openings between the vertebrae.

If a disc, bone or another structure reduces the space around a nerve, your MRI report may describe nerve root compression, nerve root impingement or similar terminology.

If the affected nerve corresponds with your symptoms, this may help explain:

• Sciatica
• Leg pain
• Arm pain
• Numbness
• Tingling
• Weakness

However, the presence of nerve compression on an MRI should still be considered alongside your clinical examination.

Foraminal Narrowing

The neural foramina are openings through which spinal nerves leave the spinal canal.

Your MRI report may describe:

"Neural foraminal narrowing"

or:

"Foraminal stenosis"

This means that the space around a nerve has become narrower. This can occur because of changes involving the discs, joints or surrounding bone. If the narrowing affects a nerve, it may contribute to nerve-related symptoms.

Spinal stenosis

Spinal stenosis means narrowing of the spaces within or around the spinal canal.

It can occur in different parts of the spine and may have different causes.

In the lower back, spinal stenosis can sometimes be associated with symptoms such as:

• Leg pain
• Numbness
• Tingling
• Weakness
• Symptoms that become worse with standing or walking

The severity and location of the narrowing are important when interpreting the MRI.

Degenerative Disc Changes

Your MRI report may describe:

• Disc degeneration
• Degenerative disc disease
• Disc desiccation
• Loss of disc height
• Reduced disc signal
• Endplate changes

These terms generally describe changes to the structure of the discs and surrounding vertebrae that can occur over time. Degenerative changes are common as we age. Importantly, the presence of degeneration on an MRI does not automatically mean that it is the cause of your pain.

Your symptoms and examination remain important when deciding whether these findings are clinically significant.

What does 'disc dehydration' or 'disc desiccation' mean?

Healthy spinal discs contain a relatively high amount of water.

As discs change over time, they can lose some of this water content. On MRI, this may be described as:

Disc desiccation

or:

Disc dehydration

This is commonly associated with the normal ageing and degenerative process. It does not necessarily mean that the disc is causing your pain.

What does 'loss of disc height' mean?

A disc can gradually become thinner as structural changes develop within it.

Your MRI report may therefore describe:

"Reduced disc height"

or:

"Loss of disc space height"

This may occur alongside other degenerative changes. Again, the finding needs to be considered in the context of your symptoms rather than viewed in isolation.

What does 'nerve irritation' mean?

A nerve can become irritated without being severely compressed.

Depending on the affected nerve, irritation can produce symptoms such as:

• Shooting pain
• Burning pain
• Pins and needles
• Numbness
• Altered sensation
• Weakness

When symptoms travel into the leg from the lower back, this is commonly referred to as sciatica.

When symptoms travel into the arm from the neck, they may be described as cervical radicular symptoms or cervical radiculopathy.

[Learn more about Sciatica →]

Does an MRI tell you exactly what is causing your pain?

Not always. This is an important distinction. An MRI can show structural abnormalities, but not every abnormality causes symptoms. For example, someone may have:

A disc bulge + no pain

or:

A disc bulge + significant back pain

or:

A disc bulge affecting a nerve + sciatica

The MRI findings may look similar in some respects, but the clinical picture is very different.

This is why we consider three things together:

1. Your symptoms

Where is your pain? Does it travel into your leg or arm? Do you have numbness, tingling or weakness?

2. Your clinical examination

What does your movement, strength, sensation and neurological examination show?

3. Your imaging

Does the MRI show a structural finding that corresponds with your symptoms and examination?

The combination of these three factors is much more informative than the MRI report on its own.

Why the level of the disc problem matters

AYour MRI may identify a disc problem at a particular spinal level, such as:

• L3/L4
• L4/L5
• L5/S1

These are different levels of the lower spine and can affect different nerve roots. For example, a disc problem at L4/L5 may affect structures associated with different symptoms from a problem at L5/S1.

This is why we don't simply look for the words "disc bulge" or "herniation".

We consider where the disc problem is located and whether that location makes sense in relation to your symptoms.

What if my MRI shows multiple disc problems?

This is very common. An MRI report might describe changes at several levels. For example, you might be told that you have:

• A disc bulge at L3/L4
• A disc protrusion at L4/L5
• Disc degeneration at L5/S1

It can be tempting to assume that all of these findings are contributing to your symptoms. That isn't necessarily the case. A clinical assessment can help identify which findings are more likely to be relevant and which may simply represent background changes.

Does a severe looking MRI mean severe pain?

Not necessarily. The relationship between structural changes seen on MRI and pain is not always straightforward. Some people with relatively significant-looking MRI findings have surprisingly few symptoms. Others can experience considerable pain despite relatively modest structural findings.

Pain is influenced by multiple factors, and an MRI should therefore be viewed as one part of the assessment rather than a complete explanation for your symptoms.

Do I need an MRI for back pain or sciatica?

Some people with a herniated disc will get better through a combination of hands on treatment, home exercises and activity modification. However, where symptoms are more severe, long lasting, recurring or quality of life is significantly affected, IDD provides a valuable option.

What if IDD isn't right for me?

This is an important part of our approach. We don't believe that IDD is the answer to every disc problem.

Depending on your presentation, we may recommend:

• Osteopathic treatment
• Exercise and rehabilitation
• Medical assessment
• Further imaging or investigation
• Referral to a spinal surgeon
• Another appropriate treatment approach

Our priority is finding the right approach for your condition, not simply providing a particular treatment.

Frequently Asked Questions

Can IDD treat a herniated disc?

Yes. Herniated discs are the most common problem that we treat with IDD Spinal Decompression.

Can IDD treat a bulging disc?

Not all disc bulges require treatment but if you are experiencing associated symptoms, especially nerve pain, IDD is a valuable treatment option.

Is IDD the same as spinal decompression?

IDD is a specific form of computer-controlled spinal decompression treatment. It is delivered using a specialised system with treatment parameters adjusted for the individual.

Do I need an MRI before IDD?

Yes. An appropriate MRI is required before beginning treatment.

How many treatments will I need?

The standard protocol is 20 sessions over an eight week period. We always start with 10 then make a decision about whether to continue. Due to the nature of the treatment we do not recommend a treatment plan of less than 10 sessions.

Ready to find out whether IDD is appropriate for you?

Not necessarily. Most people with straightforward low back pain or sciatica do not automatically need an MRI. The National Institute for Health and Care Excellence (NICE) recommends against routinely offering imaging for low back pain with or without sciatica in non-specialist settings. Imaging may be considered in specialist care when the result is likely to change management.

An MRI may become more relevant when symptoms are persistent, when there are significant neurological findings, when a specific diagnosis needs to be investigated, or when the result would influence treatment decisions.

Why we require an MRI before IDD

iIf you are considering IDD Spinal Decompression, an appropriate MRI is required before beginning treatment.

This is because we need to understand the structure of your spine and identify:

• The relevant spinal level
• The type and location of any disc problem
• The relationship between the disc and surrounding structures
• The degree of any spinal canal or foraminal narrowing
• Other findings that may affect whether IDD is appropriate

The MRI is not used on its own to determine whether you are suitable for IDD.

Your symptoms, clinical examination, medical history and imaging are considered together.

[Learn more about IDD Spinal Decompression →]

[IDD for Sciatica →]

[IDD for Herniated & Bulging Discs →]

Can an MRI show why I have sciatica?

iSometimes it can provide an important piece of the puzzle.

For example, an MRI may show a disc protrusion that corresponds closely with the distribution of your leg pain and clinical findings.

However, not every disc abnormality causes sciatica.

If you have sciatica, we therefore assess:

• The location and distribution of your pain
• Sensory symptoms
• Muscle strength
• Reflexes
• Spinal movement
• Relevant neurological tests
• Your MRI findings

This helps us determine whether there is evidence of nerve involvement and whether the MRI findings are likely to be clinically relevant.

[Sciatica Treatment →]

What if my MRI says 'nerve compression'?

Nerve compression can sound alarming, but the significance depends on which nerve is affected, how much it is affected and whether your symptoms correspond with the finding.

Some people with radiological nerve compression have relatively mild symptoms. Others can develop significant pain, numbness or weakness. If you have progressive weakness or significant neurological symptoms, appropriate medical assessment is important.

When should you seek urgent medical attention?

Back pain and sciatica are very common, but certain symptoms require urgent medical assessment.

Seek urgent medical attention if you develop symptoms such as:

• New difficulty controlling your bladder or bowel
• Numbness around the genitals, anus or inner thighs
• Significant or rapidly worsening weakness in the leg or foot
• Severe symptoms following significant trauma
• Other new or rapidly worsening neurological symptoms

These symptoms can occasionally indicate a more serious spinal problem and should not simply be treated as routine back pain or sciatica..

Can you explain my MRI report?

If you have already had an MRI, we can discuss the findings as part of your clinical assessment.

We can help explain terminology such as:

"L4/L5 disc protrusion"

"L5/S1 nerve root compression"

"Moderate foraminal stenosis"

"Multilevel degenerative changes"

and explain how these findings may or may not relate to your symptoms. However, we cannot determine the significance of an MRI finding from the report alone. Your symptoms and clinical examination are an essential part of the assessment.

Understanding your MRI report shouldn't mean worrying about every word

MRI reports can make relatively common spinal changes sound frightening. Words such as degeneration, bulging, protrusion, stenosis and compression can understandably cause concern.

But an MRI finding is not a diagnosis of how much pain you should have, nor does it automatically mean that your spine is seriously damaged.

The most useful question is:

Does the finding on the MRI make sense when considered alongside my symptoms and examination?

That is the approach we take when assessing patients at Leyton Osteopaths.

How we can help

If you have persistent back pain, sciatica or other spinal symptoms and have an MRI report that you don't fully understand, an assessment can help put the findings into context.

We can:

• Discuss your symptoms
• Perform an appropriate physical and neurological examination
• Review relevant MRI findings
• Explain the terminology used in your report
• Discuss whether the findings are likely to be relevant to your symptoms
• Explain appropriate treatment options
• Recommend further medical assessment where necessary

If you are considering IDD Spinal Decompression, we can also assess whether it is an appropriate option based on your individual circumstances.

[Book a Disc & Sciatica Assessment]

Frequently asked questions

Is a disc bulge serious?

Not necessarily. Disc bulges are common and may be present without causing symptoms. Their significance depends on their location and relationship to your symptoms and clinical findings.

Does a bulging disc mean I have a slipped disc?

Not necessarily. "Bulging disc" and "slipped disc" are commonly used terms, but they can describe different types of disc changes.

Can an MRI show sciatica?

An MRI cannot show "pain" or sciatica itself. It can show structural findings that may explain irritation or compression of a spinal nerve associated with sciatica.

Can an MRI show a pinched nerve?

An MRI can show structural changes that may compress or narrow the space around a nerve. Whether this is causing your symptoms needs to be determined clinically.

Does everyone with sciatica need an MRI?

No. MRI is not routinely required for straightforward low back pain or sciatica. It may be appropriate when the findings are likely to change management or when there are particular clinical concerns.

Can an MRI tell me whether I need surgery?

An MRI can provide important information, but the decision about surgery depends on the whole clinical picture, including symptoms, neurological findings, imaging and response to treatment. Surgical decisions should be made with the appropriate medical specialist.

Can I have IDD without an MRI?

No. An appropriate MRI is required before beginning an IDD treatment programme at Leyton Osteopaths.

Can you tell me whether IDD will work from my MRI?

Not from the MRI alone. We need to consider your symptoms, examination, medical history and imaging before deciding whether IDD is appropriate.