Scary Spine Models

March 21st, 2012

Here is a great article from Paul Ingram-

Those scary spine models • How hopelessly obsolete clinical ideas persist for years, even decades

Anatomical models of lumbar spines almost all include a herniated disc — in spite of the fact that the last quarter century of scientific research has consistently shown that herniated discs are of minimal clinical significance in the vast majority of back pain. The niftiest science fact about herniated discs is that so many people have asymptomatic disc herniations — at least 25% of people, many more according to some research, are walking around with diagnosable disc herniations … and yet they have no symptoms at all.

And so, although herniated discs do happen, they are typically much less common and much less serious than most patients, doctors and therapists believe. Meanwhile, several respected experts have made strong statements about the extreme importance of reassuring low back pain patients and not scaring them with ominous-sounding and diagnoses like “herniated disc.” Such diagnoses are usually wrong, or hopelessly oversimplified at best, and needlessly scare the wits out of patients … which is a known risk factor for low back pain.

Nervous low back pain patients tend to have more pain for much longer.

And yet it remains nearly impossible for a clinician to buy an anatomical model of the lumbar spine that doesn’t have a little rubber disc bulging ominously from the spine … invariably coloured bright red, just to hammer the point home! It is also nearly impossible for a patient to look at such a model without worrying.

Model of doom and gloom

Lumbar spine models like this almost all show a herniated disc. Some go a step further and show discs slipped so far they’ve completely left the spine! (Hat tip to Dr. Moseley.)

That little bulging disc looks bad. Or, God forbid, a disc that has “slipped so far out it’s sitting on its own?” Here’s pain researcher Lorimer Moseley making this point in a great TED talk. He’s talking about how pain is always worsened when you believe that there is danger … and plastic anatomical models of slipped discs are much too persuasive.

Any piece of credible evidence that they are in danger should change their pain … And they are all walking into a hospital department with models like this on the desk: what does your brain say when it sees a disc that’s slipped so far out it’s sitting on its own? If you’ve ever seen a disc in a cadaver, you can’t slip the suckers — they’re immobile, you can’t slip a disc — but that’s our language, and it messes with your brain. It cannot not mess with your brain.

Lorimer Moseley, from his surprisingly funny TED talk, Why Things Hurt 14:33

(I laughed out loud at that, and then cheered. I’ve been bitching about these blasted models for years. Long before I’d ever heard of Lorimer, I’m proud to say.)

Such models undoubtedly also influence professionals. Even if they accept that it’s an oversimplified model, the prominence of herniated discs in most models and anatomical drawings constantly exaggerates their importance.

Anatomical models aren’t cheap, and once a clinician has purchased one, it is likely to stay in his or her office for years, probably even decades. I’m sure there are probably hundreds of thousands of them in offices around the world that are at least twenty years old, and clinicians are still buying new ones right now!

And so this is a great example of how hopelessly obsolete clinical ideas persist for years, even decades, after the field has moved on.

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