Low Back Pain and Imaging Explained

By Jess Leberman, DPT – Hampton Clinic ~

Low back pain (LBP) is a significant condition in the general population making it the leading cause of daily activity and work related limitations and absences. It is estimated the lifetime prevalence of non-specific low back pain is 60% to 70%. LBP places a significant burden on individuals, families, and work places. For that reason, LBP is consistently the most commonly treated condition by outpatient physical therapists.

Frequently, patients visit emergency departments or primary care physicians with complaints of low back pain that is addressed with imaging and possible medication prescription. Imaging such as x-rays and MRIs often show abnormalities within the spine. Common findings on imaging of the lumbar spine include; disk degeneration, facet degeneration, and disk protrusion, which, can be interpreted as causes of back pain. In many cases these findings on imaging result in medical or surgical intervention that may or may not alleviate the symptoms. But how come when addressing these abnormalities found on imaging, does it not always alleviate the pain?1

Research Findings

Brinjikji W, et al studied the age-specific prevalence of the following imaging findings in asymptomatic individuals: disk degeneration, disk signal loss, disk height loss, disk bulge, disk protrusion, annular fissures, facet degeneration, and spondylolisthesis (a slipping of vertebrae).

The table below displays the percentage of individuals without Lower Back Pain that displayed changes on imaging;2

So what does this all mean?

Well simply put, imaging of the lumbar spine does not tell the whole story. There is a large proportion of people who display abnormalities within the lumbar spine on imaging, however, present with no low back pain. Based on the research, it can be suggested that more than 50% of those 40 years and older without Low Back Pain display disk degeneration or bulging meaning that even in a younger population changes within the lumbar spine. The research validates the statement that changes seen on imaging of the lumbar spine are considered normal in all age groups and may not be the direct cause of pain. These findings lend itself to the question, if I have general low back pain, is it necessary to get x-rays or an MRI? At Hampton Physical Therapy our Doctors of Physical Therapy specialize in evaluating low back pain, diagnosing the cause and assessing the need for further imaging.

Choose PT first for low back pain!

Contact Hampton PT for a Free Discovery Visit (or sign up online)!


  1. Duthey B. Background Paper, BP 6.24 Low back pain. World Health Organization. March 2013. https://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf. Accessed May 28, 2019.
  2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. doi:10.3174/ajnr.A4173


Hampton Physical Therapy Clinics Now Certified in Blood Flow Restriction Training

Hampton Physical Therapy, with clinics in both Hampton and Seabrook, NH is proud to announce that all of their therapists have received certifications in Blood Flow Restriction “BFR” Training .

Blood flow restriction training is a method of strength training that involves restricting the blood flow to working muscles to trick the body into getting stronger by creating a metabolic stress response. It is achieved through the application of external pressure over the extremities. The goal is to enable patients to make greater strength gains while lifting lighter loads, thereby reducing the overall stress placed on the limb. Muscle hypertrophy, or muscle growth, requires either mechanical stress (lifting heavy loads) or metabolic stress (hormones and metabolites).

In the rehabilitation setting, achieving muscle loading at a threshold high enough to induce muscle hypertrophy is very difficult. BFR allows us to safely train muscles at very load loads, limit muscle and joint strain, while achieving the same results as heavy loading. We can now maximize strength gains safer and faster without the side effects of traditional load based training like delayed onset muscle soreness, joint stress, and micro tearing! We are excited to offer this service to our patients.

Patients no longer have to do max repetitions to achieve strength gain!

Blood flow restriction training is surprisingly comfortable. The pressure cuff induces muscle fatigue relatively quickly and with very little strain. A trained physical therapist, with the aid of a Doppler ultrasound, will determine individual blood pressure values and customize a protocol. The use of a Doppler and individualization of restriction pressure is vital to the safety and effectiveness of this technique. After the appropriate pressure is validated, a special restriction cuff is placed on 1-4 limbs during the duration of a prescribed exercise program. The exercise program can be aerobic, restive or a combination of the two. The exciting thing about BRF training is that the effect is systemic, therefore affecting the whole body. Using this method has total body benefit due to its action on hormones and growth factors that act on multiple systems.

“This is an ideal therapy for most orthopedic post-operative patients. BRF will allow you to build muscle sooner during the early phase of your rehab program. Most protocol’s are limiting early on in recovery in order to protect the joint or repair. BFR will now allow us to safely help you build muscle sooner!” says owner of Hampton PT, Kate Serodio

“We are very excited to be on the forefront of the latest rehabilitation and performance methods. As research uncovers safer, faster, and more effective techniques, we strive to be the first to offer these to our patients and clients. Additionally, we take great pride in the fact that our therapists are some of the best educated in the field. We strongly encourage our therapist to be over-educated!” says Pinnacle Rehabilitation Network Vice President Dan Fleury. Hampton Physical Therapy is a Pinnacle Rehabilitation Network Partner.

Local Pinnacle Rehab network affiliated sites currently performing BFR: Hampton Physical Therapy, Portsmouth Physical Therapy, and Somersworth Physical Therapy.