Question
Hi i had a MRI about 2 weeks ago showing that mild posterior disc bulge, no strains or compression of roots? could my ostiopath be able to help?  

Answer
Dear Satty,

Yes your Osteopath can help if they manipulate.  Spinal manipulation has been found to be very helpful in the treatment and resolution of back pain in conjunction with disk bulges.  In your case the MRI results are very favorable for manipulation.

A mild disk bulge can be interpreted as essentially a normal finding on MRI, as they have been found in up 50% of the normal population without any pain or dysfunction, although this is subject to some discussion considering sex, age, and predisposing trauma or injuring event. (see Below)

Early studies of CT and MRI have been the source of some confusion and this deserves some comment here. In 1984 a paper appeared in the journal "Spine", noting that in the over-40 age group, more than 50% of the scans of asymptomatic subjects were abnormal (1). The subsequent spin applied to this statistic, from various sources, was that "50% of all normal people have a disc bulge or disc herniation." However, the abnormalities described by the original authors included such frequently benign findings as facet arthrosis and spondylosis (arthritic changes). Disorders such as disc herniation were seen in only 19% of subjects in the under-40 age group. This is in line with other reports of asymptomatic disc bulge/herniation; these range from 4-28% and are more common in the elderly (2). Most importantly, however, these studies are somewhat contrived and artificial, lacking by their very design, a fundamental component of the diagnostic equation--namely that of clinical interpretation. Radiologists blinded in such studies are generally challenged to report all of the pathology they see, as opposed to the pathology they would usually report as significant, given the clinical history provided to them by clinicians. And, of course, knowing the prevalence of HNP (disk bulge) in the healthy population, while of academic interest, tells us little about the prevalence nor the significance of HNP in the patient population. On of the first lessons of epidemiology is that one must never extrapolate from one population to another.

Now, back on track...I am assuming your pain is mostly in the local area of the low back, with maybe some mild radiation of pain into the buttock or thigh because of information that there is no nerve root compression. You should see significant improvements in any symptoms with 4-6 visits to a skilled doctor for manipulation

Worldwide, Chiropractic Physicians account for 95% of all spinal manipulative therapies.  The remaining 5% are performed by Osteopathic physicians, and medical doctors, although they do not have as comprehensive training as chiropractors do concerning biomechanics, or spinal manipulation. Therefore, ask your osteopath if he/she is trained in spinal manipulation, and then make sure that this is a technique they use frequently.  Make sure they can explain the neuromechanics of joint manipulation as well as the physical properties of the disk.  If they are not proficient with information pertaining to the above questions or these types of maneuvers, then you should find a good chiropractic physician in your area to address the problem.

1) Weisel S: A study of computer assisted tomography: I. the incidence of positive CAT scans in an asymptomatic group of patients. Spine 9(6):549-551, 1984.

2) Kent DL, Haynor DR, Larson EB, et al.: Diagnosis of lumbar spinal stenosis in adults--a meta-analysis of the accuracy of CT, MR and myelography--review. Am J Roentgenol
158(5):1135-1144, 1992.

Satty, hope this helps shed some light on your MRI as well as your questions. If you need any help with a referral to a chiropractic physician, get back in touch with me and I will do my best to help.

Respectfully,
Dr. J. Shawn Leatherman