In a lengthy letter, one of our readers describes issues with her chronic lower back pain. She is very physically active, attending high-intensity group workouts, which she wishes to continue. MRI scans show minor degenerative changes, and she asks if an exercise program could be developed for her based on the scans so that she does not have to come in for an examination. She lives in Zagreb.

There are things that, despite the best intentions, cannot be resolved via a mobile app or email. One of these is diagnostics in musculoskeletal medicine, and the other is therapy. Perhaps this option will exist in some indefinite future, but it is not available today.

Imagine you feel pain in your left heel while walking. You take off your shoe and see a blister. The first thing you will ask yourself is what caused the blister. Common causes are: a shoe that is too tight, a shoe that is too loose, laces tied too tightly or too loosely, bad socks… The same mental process occurs in the mind of an orthopedist or physiotherapist when making a diagnosis. In this case, MRI scans indicate where the “blister” is, or the location of the pain. Just as a simple photograph of the blister on the heel would indicate its location and size, an MRI shows the location and size of the pathological change. However, just as a photograph of a blister does not show the condition of the shoe, an MRI cannot indicate possible causes of these changes.

Degenerative and consequently inflammatory changes in the lumbar spine are, in most cases, the result of cumulative, gradual damage, resulting from overloading. The most common culprits are mobility disorders of the thoracic spine, hips, lower extremities (stiffness, shortened muscles, limited mobility), then localized or general muscle weakness, excessive or poorly directed physical activity, etc. None of these conditions can be read from MRI findings or other imaging diagnostics. This requires a proper and detailed examination, as well as a detailed medical history, in this specific case including the diagnosis of the training process, followed by individual therapy tailored to correct the identified deficiencies.