# MRI scans of the lumbar spine in lower back pain—why are we missing the elephant in the room?

## TL;DR

MRI scans for lower back pain often focus on disc degeneration but miss reversible muscle issues that could guide better treatment.

## Contribution

Highlights the importance of reporting muscle health in MRI scans to improve lower back pain rehabilitation.

## Key findings

- MRI reports often overlook muscle fat infiltration and atrophy in lower back pain patients.
- Muscle condition is a reversible factor that could guide targeted exercise rehabilitation.
- Focusing on disc changes may limit effective treatment for lower back pain.

## Abstract

Lower back pain (LBP) is a leading cause of disability worldwide and a major contributor to healthcare costs. Diagnosing non-specific mechanical LBP remains difficult and often relies on exclusion. Current magnetic resonance imaging (MRI) reports typically emphasize disc degeneration, an age-related and often asymptomatic finding, while overlooking more clinically relevant factors like the state of the muscle. Fat infiltration and muscle wasting seen on MRI scans are common in LBP patients and are potentially reversible with targeted exercise rehabilitation. In a recent case, MRI revealed significant fat infiltration and muscle atrophy, yet the report focused solely on disc changes, missing the elephant in the room: the correctable muscular dysfunction. Since exercise is the cornerstone of LBP management, ignoring modifiable muscle health while highlighting irreversible and non-pathological age-related changes limits targeted treatment guidance. Routine reporting of muscle condition could lead to more precise rehabilitation and improved patient outcomes.